EXHIBIT 10.1
CONTRACT C2297
CONTRACT BETWEEN
THE DEPARTMENT OF CORRECTIONS
AND
PRISON HEALTH SERVICES, INC.
This Contract's between the Florida Department of Corrections ("Department") and
Prison Health Services, Inc. ("Contractor") which are the parties hereto.
WITNESSETH
Whereas, the Department is responsible for the inmates and for the operation of,
and supervisory and protective care, custody and control of, all buildings,
grounds, property and matters connected with the correctional system in
accordance with Section 945.04, Florida Statutes;
Whereas, it is necessary that budget resources be allocated effectively;
Whereas, this Contract is entered into pursuant to the Department's Invitation
To Bid (ITB) #05-DC-7666, authorized pursuant to Section 287.057 (1), Florida
Statutes; and
Whereas, the Contractor is a qualified and willing participant with the
Department to provide comprehensive healthcare services to the Department's
inmates in Region IV.
Therefore, in consideration of the mutual benefits to be derived hereby, the
Department and the Contractor do hereby agree as follows:
I. CONTRACT TERM AND RENEWAL
A. Contract Term
This Contract shall begin on January 1, 2006, and shall end at
midnight on December 11, 2010.
This Contract is in its initial term.
B. Contract Renewal
The Department has the option to renew this Contract for one (1)
additional five (5) year period after the initial Contract period
upon the same terms and conditions contained herein and at the
renewal prices indicated in Section III, Compensation. Exercise of
the renewal option is at the Department's sole discretion and shall
be conditioned, at a minimum, on the Contractor's performance of
this Contract and subject to the availability of funds. The
Department, if it desires to exercise its renewal option, will
provide written notice to the Contractor no later than sixty-five
(65) days prior to the Contract expiration date. The renewal term
shall be considered separate and shall require exercise of the
renewal option should the Department choose to renew this Contract.
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II. SCOPE OF SERVICE
A. General Description of Services
This Contract is a fall risk Contract without any caps or aggregate
levels after which costs are shared. The Contractor shall be
responsible for all costs associated with the provision of
comprehensive healthcare services in Region IV as described or
referenced in this Contract, including the cost of Pharmaceuticals.
The Contractor shall provide comprehensive and medically necessary
medical, dental and mental healthcare services with related pharmacy
services (including provision of Pharmaceuticals) on a capitation
basis to inmates in Region IV that meet or exceed the minimum
requirements outlined in this Contract. This includes all healthcare
treatment and related program support services. No deviations from
the minimum service requirements shall be permitted without the
prior written approval of the Department; otherwise, it shall be
considered that this Contract will be performed in strict compliance
with the requirements and rules, regulations and governance
contained herein. The Contractor and the Department shall each act
in good faith in the performance of all their respective contract
duties and responsibilities.
The Contractor shall also provide comprehensive healthcare services
for inmates at allied facilities in Region IV, including road
prisons, work camps and work release centers with the exception of
inmates covered by insurance or workers' compensation. For inmates
housed at these allied facilities, healthcare services may be
provided in the community and billed to the Contractor or, depending
on circumstances and with the approval of the Regional Contract
Monitor and Transfer Coordinator, the inmate may be returned to the
correctional institution in Region IV with assigned coverage for the
respective allied facility. The Contractor and the Department's
Director of Health Services-Administration or designee will agree
upon these situations on a case-by-case basis.
Access to and provision of all services outlined herein will be in
accordance with minimum constitutionally adequate levels of
healthcare regardless of place of assignment or disciplinary status.
The Contractor is required to provide comprehensive healthcare
service coverage twenty four (24) hours a day seven (7) days a week
at each institution. The Contractor shall not be responsible for
housekeeping services, food/dietary services, building maintenance,
non- medical linens and routine transportation. The Contractor is,
however, responsible for the provision of and costs for medical
linens, infirmary mattresses (including SOS mattresses) and other
infirmary and emergency room supplies, and both urgent and emergency
medical transportation. (Note: Medical linens typically include
sheets, pillow cases, cotton blankets, draw sheets, cloth bed pads,
patient pajamas and/or gowns, turning pads, towels and wash cloths.
Infirmary mattresses and pillows typically have vinyl or plastic
covers, and SOS mattresses are normally made from heavy duty plastic
or vinyl which is seamless and resistant to being torn into strips.
These differ from the inmate housing unit mattresses and pillows.)
The Contractor may utilize the Department's current healthcare
services contracts with other healthcare providers, provided the
Contractor obtains a Letter of Agreement from both the Department
and the contractor in question in advance, making the Contractor
financially responsible for any costs incurred. (See current list of
healthcare providers, EXHIBIT A, OHS Contract List.) The Contractor
shall utilize only hospitals approved by the Department
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with a secure prison xxxx to minimize security costs unless other
arrangements to contain such costs are made and approval is obtained
in writing from the Contract Manager. (See EXHIBIT B, Approved
Region IV hospitals). If the Contractor identifies additional
hospitals in the Region IV geographical area that could be used in a
similar manner, it may contract for those hospital's services,
however, any security arrangements shall be subject to prior
Department approval. Emergency medical healthcare services shall be
obtained from the hospital nearest the correctional facility, as
required by law.
To assist the Contractor in minimizing security costs, the
Contractor may utilize the services available at the Department's
Reception and Medical Center (RMC) Hospital at Lake Xxxxxx in all
appropriate cases contingent upon space availability. The Contractor
shall comply with the procedures for accessing and utilizing these
services as outlined in HSB 401.005 UTILIZATION MANAGEMENT
COORDINATING HEALTH SERVICES FOR INMATES IN CONTRACT INSTITUTIONS.
Services available include:
1. 157 bed general hospital - Approximately 120 medical beds, 33
mental health beds;
2. Medical dormitories functioning as extended care units;
3. Specialty clinics with physicians in almost all specialties;
4. Mobile surgery suite - surgeries performed are essentially the
same as performed in a freestanding ambulatory surgical center,
e.g. hernia repair, hemorrhoidectomy, cyst removals; and
5. Oncology services, including chemotherapy.
A schedule of services available and associated charges is attached
as EXHIBIT C, RMC Fee Schedule dated July 1, 2005. Any inmate
transferred to RMC under this arrangement will remain the financial
responsibility of the Contractor and will normally be returned to
Region IV upon completion of treatment.
The Contractor shall establish regular meetings with representatives
from the Office of Health Services, the designated hospital(s) and
other providers to coordinate the referral of inmates. The
Contractor shall inform the referring institution's Warden of these
meetings. The Warden or designee, and the Regional Contract Monitor
or designee may attend. The Contractor or designated institutional
representative shall meet monthly with the Regional Contract Monitor
and weekly with the institutional Warden.
B. Health Care Standards
Documentation of licensure and accreditation for all hospitals,
clinics and other related health service providers to be utilized by
the Contractor (with the exception of the RMC Hospital) shall be
made available to the Department upon request. All hospitals
utilized by the Contractor for the care of inmates shall be fully
licensed and preferably accredited by the Joint Commission on
Accreditation of Healthcare Organizations (JCAHCO). All hospitals
utilized by the Contractor require prior written approval by the
Department's Contract Manager, identified in Section IV., A., of
this Contract.
C. Rules, Regulations and Governance
1. The Contractor shall provide all healthcare treatment and
services in accordance with all applicable federal and state
laws, rules and regulations, Department of Corrections' rules,
procedures, and Health Services' Bulletins/Technical Instructions
(HSB's /TPI's) applicable to the delivery of healthcare services
in a correctional setting. In addition, the Contractor shall meet
all state and federal constitutional requirements, court orders,
and
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applicable ACA Standards for Correctional healthcare (whether
mandatory or non- mandatory). All such laws, rules and
regulations, current and/or as revised, are incorporated herein
by reference and made a part of this Contract. The Contractor and
the Department shall work cooperatively to ensure service
delivery in complete compliance with all such requirements.
2. The Contractor shall ensure that all Contractor's or
subcontracted staff providing services under this Contract
complies with prevailing ethical and professional standards, and
the rules, procedures and regulations mentioned above.
3. Should any of the above laws, standards, rules or regulations,
Department procedures, HSB's/TPI's or directives change during
the course of this Contract term, the updated version will take
precedence. The Department shall provide the Contractor with a
copy of all rules, regulations, department procedures,
HSB's/TI's and directives.
4. The Contractor shall comply with all applicable continuing
requirements as determined by the Department's Director of Health
Services-Administration for reports to and from the Department,
Correctional Medical Authority and the Healthcare Contract
Monitoring Team.
5. To the extent required as a business associate of the Department,
the Contractor shall comply with the Health Insurance Portability
and Accountability Act of 1996 (42 U. S. C. Section 1320d-8), and
all applicable regulations promulgated thereunder. Such
compliance shall be required as outlined in ATTACHMENT #1
Business Associate Agreement, which is incorporated herein as if
fully stated.
6. The Contractor will be required to maintain full accreditation by
the American Correctional Association (ACA) for the healthcare
operational areas in all institutions in which healthcare
services are provided. Failure to maintain accreditation will
result in the assessment of liquidated damages as set forth in
Section 3.32. (Information on the ACA is available on their
web-site at xxxx://xxx.xxxxxxxxxxx.xxx/xxx/ and the ACA standards
are listed on the Department's web-site at
xxxx://xxxxx/xx/xx/xxxxxx/0000.xxx.)
7. The Contractor shall ensure that all subcontractor agreements are
approved by the Department's Contract Manager and contain
provisions requiring the subcontractor to comply with all
applicable terms and conditions of this Contract.
8. The Contractor agrees to modify its service delivery, including
addition or expansion of comprehensive healthcare services in
order to meet or comply with changes required by operation of law
or due to changes in practice standards such as ACA standards,
regulations, or as a result of any legal settlement agreement
involving delivery of healthcare to inmates or related consent
order or change in the Department's mission.
9. Any changes in the scope of service required to ensure continued
compliance with State or Federal laws, statutes or regulations,
legal settlement agreement or consent order or Department policy,
procedures, regulations, HSB's/TI's or directives or practice
standards will be made in accordance with Section V., Contract
Modifications.
D. Communications
1. Contract communications will be in three forms: routine, informal
and formal. For the purposes of the Contract, the following
definitions shall apply:
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Routine: All normal written communications generated by either
party relating to service delivery. Routine communications must
be acknowledged or answered within thirty (30) calendar days of
receipt.
Informal: Special written communications deemed necessary based
upon either contract compliance or quality of service issues.
Must be acknowledged or responded to within fifteen (15) calendar
days of receipt.
Formal: The same as informal but more limited in nature and
usually reserved for significant issues such as Breach of
Contract, failure to provide satisfactory performance, imposition
of liquidated damages, or termination. Formal communications
shall also include requests for changes in the scope of the
Contract and billing adjustments. Must be acknowledged upon
receipt and responded to within seven (7) days of receipt.
2. The Contractor shall respond to Informal and Formal
communications by facsimile, with follow-up by hard copy mail.
3. A date/numbering system shall be utilized for tracking of formal
and informal communication.
4. The only personnel authorized to use formal contract
communications are the Department's Director of Health
Services-Administration, Contract Manager, Contract
Administrator, Healthcare Contract Monitor, the Contractor's CEO
or Project Manager. Designees or other persons authorized to
utilize formal Contract communications must be agreed upon by
both parties and identified in writing within ten (10) days of
execution of the Contract. Notification of any subsequent changes
must be provided in writing prior to issuance of any formal
communication from the changed designee or authorized
representative.
5. In addition to the personnel named under Formal Contract
Communications, personnel authorized to use Informal Contract
Communications are the Warden, Regional Contract Monitor,
Contract Administrator and any comparable corporate positions on
behalf of the Contractor or other persons designated in writing
by the Contractor.
6. In addition to the contract communications noted in Section D.,
1., if there is an urgent administrative problem, the Department
shall make contact with the Contractor and the Contractor shall
orally respond to the Contract Manager within two (2) hours. If a
non- urgent administrative problem occurs, the Department will
make contact with the Contractor and the Contractor shall orally
respond to the Contract Manager within forty eight (48) hours.
The Contractor or designee at each institution shall respond to
inquiries from the Department by providing all information or
records that the Department deems necessary to respond to
inquiries, complaints or grievances from or about inmates within
three working days of receipt of the request unless such
information or records is of a type or quantity that cannot
reasonably be gathered in this time period, in which case, the
Contractor shall be given a reasonable period of time to provide
such information or records. The Regional Contract Monitor and
Contract Manager shall be copied on all such correspondence.
E. Final Implementation Plan and Transition Date Schedule
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1. Implementation of service shall commence on January 1, 2006. The
Contractor's Estimated Implementation Plan and Transition Date
Schedule for Region IV submitted with the bid (per Section
5.2.11) shall be adjusted as necessary and approved as
Contractor's Final Implementation Plan and Transition Date
Schedule by the Contract Manager.
2. The Final Implementation Plan shall be designed to provide for
seamless transition with minimal interruption of healthcare to
inmates. Final transition at each institution shall be
coordinated between the Contractor, the current Region IV
contractor (Wexford Health Sources, Inc.,) and the Department.
3. The Contractor shall commence provision of comprehensive
healthcare services to the Department's inmates consistent with
the approved Final Implementation Plan and Transition Date
Schedule.
4. The Contractor shall assume 100% responsibility for the delivery
of comprehensive healthcare services at each designated
institution at 12:0l a.m., on January 1, 2006.
F. Institutions/Facility Locations and Service Times
1. Institutions/Facility Locations: The facilities to be included
under this Contract include all currently operating Region IV
institutions and allied facilities as indicated in EXHIBIT D.
2. Add/Delete Institution/Facilities for Services: The Department
reserves the right to add or delete institutions/facilities
receiving or requiring services under this Contract upon
sixty-five (65) days' written notice. Such additions or deletions
may be accomplished by letter and do not require a contract
amendment.
3. Service Times: The Contractor shall ensure access to
comprehensive healthcare services as required within the Scope of
Service twenty-four (24) hours per day, seven (7) days a week,
and three hundred sixty-five (365) days a year.
G. Administrative Requirements, Space, Equipment & Commodities
1. The Department shall not provide any administrative functions or
office support for the Contractor (e.g., clerical assistance,
office supplies, copiers, fax machines and preparation of
documents), except as otherwise indicated in this Contract.
2. SPACE AND FIXTURES: The Department will provide office space
within the health services unit. The institution shall provide
and maintain presently available and utilized health space,
fixtures and other items for the Contractor's use to ensure the
efficient operation of the Contract. The institution shall also
provide or arrange for waste disposal services, not including
medical waste disposal which shall be the responsibility of the
Contractor. The Department will maintain and repair the office
space assigned to the Contractor, if necessary, including
painting as needed, and will provide building utilities necessary
for the performance of the Contract as determined necessary by
the Department. The Contractor shall operate the space provided
in an energy efficient manner.
3. FURNITURE AND NON-HEALTHCARE EQUIPMENT: The Department will allow
the Contractor to utilize the Department's furniture, and
non-healthcare equipment currently
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in place in each health services unit. A physical inventory list
of all furniture and non-healthcare equipment currently existing
at each institution will be taken by the Department and the
current Region IV Contractor (Wexford Health Sources, Inc.) on or
before the Institution's implementation date. All items
identified on the inventory shall be available for use by the
Contractor. Any equipment (i.e., copiers) currently under lease
by the Department will be either removed or the lease assumed by
the Contractor, if acceptable to the Contractor and if permitted
by the leasing company. If the lease is either not assumable by
or transferred to the Contractor, the Contractor is responsible
for making its own leasing or purchasing arrangements. The
Contractor shall be responsible for all costs associated with
non-healthcare equipment utilized, including all telephone
equipment, telephone lines and service (including all long
distance service and dedicated lines for EKG's or lab reports),
existing copy machines or facsimile equipment, and is responsible
for all costs, including installation, of any additional phone,
fax or dedicated lines requested by the Contractor. The
Department will not be responsible for maintaining any furniture
and non-healthcare equipment identified on the Department's
inventory, including repair and replacement (including
installation) of Department-owned equipment. Any equipment
damaged or otherwise found to be beyond economical repair after
the Contract start date will be repaired or replaced by the
Contractor. All inventoried furniture and non-healthcare
equipment identified on the inventory sheet shall remain the
property of the Department upon expiration or termination of the
contract. All furniture and non-healthcare equipment purchased by
the Contractor shall remain the property of the contractor after
expiration or termination of the Contract.
4. EXISTING HEALTHCARE EQUIPMENT: A physical inventory list of all
healthcare equipment owned by the Department and currently
existing at each institution will be taken by the Department and
the current Region IV Contractor (Wexford Health Sources, Inc.)
on or before each institution's implementation date. All existing
equipment shall be available for use by the Contractor. All
inventoried equipment shall be properly maintained as needed by
the Contractor and any equipment utilized by the Contractor that
becomes non-functional during the life of the Contract shall be
replaced by the Contractor and placed on the inventory list. All
inventoried equipment shall remain the property of the Department
upon expiration or termination of the Contract. "Healthcare
Equipment" is defined as any item with a unit cost exceeding one
thousand dollars ($1,000). Any healthcare equipment damaged or
otherwise found to be beyond economical repair after the Contract
start date will be repaired or replaced by the Contractor and
added to the inventory list.
5. ADDITIONAL EQUIPMENT: Any healthcare service equipment not
available in the institutional health services unit upon the
effective date of the Contract that the Contractor deems
necessary to its provision of healthcare services under the terms
of the Contract, will be the responsibility, and shall be
provided at the expense of the Contractor. The Department will
permit the Contractor, at the Contractor's expense, to install
healthcare equipment in addition to the Department-owned items on
the inventory list provided. Any additional equipment purchased
by the Contractor shall be owned and maintained by the Contractor
and shall be retained by the Contractor at Contract termination.
Any additional equipment purchased, replaced or modified by the
Contractor shall meet or exceed the Department's standards for
functionality, sanitation and security as determined by the
Department's Office of Health Services. To ensure compliance with
all Security requirements, the Contractor shall obtain written
authorization from the Contract Manager when repairing or
replacing any non-Department owned medical healthcare service
equipment.
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6. HEALTHCARE SUPPLIES: All supplies required to provide healthcare
services shall be provided by the Contractor. A physical
inventory of all healthcare supplies currently existing at each
institution will be taken by the current Contractor on or before
the new contract implementation date. The current Contractor
(Wexford Health Sources, Inc.) will inventory, package and remove
medical supplies not needed by the Contractor. This will be done
in coordination between the two entities. Both parties will agree
on any costs for supplies that the Contractor wishes to retain.
The Contractor will strive to have at least a thirty (30) days'
supply of medical supplies upon its assumption of responsibility
for service implementation at the institutions. A physical
inventory of all equipment and medical supplies will also be
conducted upon the expiration or termination of this Contract
with appropriate credit payable to the Contractor, in the event
the Department chooses to purchase then existing supplies. The
term "healthcare supplies" is defined as all healthcare equipment
and commodity items with a unit cost of less than one thousand
dollars ($1,000).
7. FORMS: The Contractor shall utilize Department forms as specified
to carry out the provisions of this Contract. The Department will
provide an electronic copy of each form in a format that may be
duplicated for use by the Contractor. The Contractor shall
request prior approval from the Contract Manager should he/she
wish to modify format or develop additional forms.
8. The Contractor shall not be responsible for housekeeping
services, inmate food/dietary services, building maintenance,
provision of bed linens for inmate housing, routine inmate
transportation and security. Contractor will be responsible for
healthcare specialty items utilized in the infirmary including,
but not limited to, treated mattresses and infirmary clothing.
H. Access to Comprehensive Healthcare Services Delivery System
1. All Florida Department of Corrections' inmates, regardless of
status, must have unimpeded access to healthcare services.
Contractor's healthcare staff should ensure that inmates have
access to a level of care commensurate with the severity of the
presenting symptomatology. If the needed level of care is not
available at the institution of residence, timely referral must
be made to another institution in which the necessary care is
available.
2. Access to healthcare services shall be provided by the Contractor
in the following manner:
A standardized program of routine/comprehensive, urgent and
emergency healthcare is to be available to all inmates. Emphasis
shall be placed on preventative healthcare practices. All
treatment will be rendered in accordance with Department of
Corrections' rules, policies, procedures and Health Services
Bulletins/Technical Instructions. Healthcare will be provided at
a minimum constitutionally adequate level of care. This means all
necessary healthcare will be provided either routinely, urgently
or emergently as dictated by the need to resolve the healthcare
issue presenting itself.
Upon arrival at the reception center, every inmate shall receive
a healthcare orientation in accordance with Department Procedure
403.008 and an immediate healthcare screening by qualified
healthcare nursing staff. All inmates shall receive a subsequent
intake physical examination at the reception center by a
Physician, Advanced Registered
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Nurse Practitioner or Physician Assistant. The intake physical
examination shall take place no later than seven (7) days after
the inmate is received at the reception center.
Each intake examination shall include, at a minimum, the
following: a complete history, physical exam, designated lab
work, and any specialty follow up exams deemed appropriate. The
examining physician will also prescribe any needed or appropriate
medications at this time.
Each inmate will receive a transfer screening on departure from
and on arrival to an institution as well as orientation to
healthcare services at the newly assigned institution. The
inmate's healthcare records shall be reviewed on arrival for
medication, emergency or urgent medical needs or any specialty
follow up scheduled. This would include placement in a chronic
illness clinic status if required for preventative care.
Each inmate will receive a periodic health assessment as required
by Office of Health Services' Technical Instructions (TI's).
Each inmate shall receive a health appraisal prior to being
placed in confinement.
Sick call shall be performed daily Monday through Friday and for
emergencies on Saturdays, Sundays and Holidays. Inmates must be
able to sign-up for sick call seven (7) days a week and the sick
call sign-up form shall be triaged daily by healthcare staff.
Inmates experiencing health care emergencies may request and
shall receive emergency care at any time, if indicated,
twenty-four (24) hours a day seven (7) days a week.
By statute, inmates are charged a $4.00 co-pay for any
inmate-initiated visit to a health care provider, other than for
emergency visits that require treatment. The Department will
collect inmate co-payments in accordance with Department
procedures based on appointment screen encounter entries and will
retain all co-payments collected.
I. Responsibility for and Coordination of Care
1. The Contractor shall be responsible for all inmate healthcare
services.
2. The Contractor's staff member designated as the institutional
administrator will be responsible to the institution's Warden for
coordinating and ensuring the provision of all institutional
healthcare. Questions or issues arising during the course of
daily activities that can not be resolved at the institution will
be referred to the Department's Regional Contract Monitor and/or
Contract Monitoring Team.
3. The Contractor shall provide sufficient controls over both its
contracted and employed physicians/psychiatrists to be able to
ensure strict adherence to the department's drug formulary.
Compliance with the Department's Drug Exception Request (DER)
policy is required prior to prescribing any non-formulary
medications. Subsets or restricted use of the Department's
formulary that effectively limit, in any manner, the use of the
Department's formulary are prohibited. Additionally, all
medications shall be prescribed appropriately as indicated in the
current edition of Drug Facts and Comparisons and the most recent
Physicians' Desk Reference. Contractor shall not prescribe
non-therapeutic doses, or change, increase or decrease medication
or dosages without providing ample time for the medication to
take effect as provided for in the package insert. If this
occurs, the Contractor will be considered non-compliant with the
provisions of care in the Contract. Should there be a requirement
for use of a non-therapeutic dosage or the
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need to prematurely change medication or dosages, there must be
appropriate clinical justification documented in the chart as
well as adherence to the DER process to gain approval.
Practitioners' prescribing practices will be tracked monthly and
reported by the Contractor. Prescribing practices will also be
monitored for performance measure compliance as per Section 3.30.
J. Initial Health Assessments - Intake Process
The Contractor shall provide each inmate a comprehensive physical,
dental and mental health assessment upon incarceration in accordance
with TI 15.01.06. The results shall be recorded in the inmate's
healthcare record. THIS INITIAL ASSESSMENT DURING THE INTAKE PROCESS
APPLIES ONLY TO THE REGION IV RECEPTION CENTERS AT BROWARD
CORRECTIONAL INSTITUTION AND SOUTH FLORIDA RECEPTION CENTER.
As a result of the assessments, a plan of care shall be developed as
necessary for each inmate. The Contractor shall provide, or cause to
be provided, all healthcare services in accordance with specified
healthcare standards set forth in Section 3.3.1 and consistent with
maintaining a minimum constitutionally adequate level of care.
HSB 15.03.13 defines the procedures for assigning a medical and a
work grade to inmates utilizing a physical profiling system. Each
inmate is assigned to an institution according to an overall
functional capacity designation indicated by a numerical
designation.
An overall medical grade assignment may be made at any time an
inmate has an encounter with healthcare personnel if that encounter
indicates a change. On those occasions when evaluation or
re-evaluation of an inmate's medical grade is appropriate, changes
may only be made by a clinician, or in the case of "S" category, by
a psychiatrist or psychologist. Other mental health staff may
recommend appropriate changes to the Chief Health Officer (CHO).
Either a physician, dentist, clinical associate, or a psychologist
may change a "W" grade after coordination, but only based upon a
valid medical or mental health limitation.
Anatomical defects or pathological conditions will not in themselves
form the sole basis for recommending assignment or work limitations.
While these conditions must be given consideration when
accomplishing the designation functional capacity, prognosis and the
possibility of further aggravation must be considered.
Certain institutions in the thirteen (13) institutions in Region IV
will house inmates classified in all medical grades and mental
health grades.
K. Medical Services
1. General Overview
The Contractor shall provide medically necessary medical services
and shall be responsible for all inmate medical costs for medical
care provided, including, but not limited to, inpatient and
outpatient care, emergency services, initial screening for pre-
existing conditions, detoxification of substance abusers and
provision of eyeglasses and hearing aids.
The Contractor will make every effort, in coordination and
cooperation with the institutional Warden, to administer as much
healthcare as is practical to inmates housed in the confinement
or close management units, at those locations. This includes Sick
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Call. The Warden will make every effort to provide appropriate
facilities at the respective housing unit.
2. Sick call shall be provided in compliance with Procedure 403.006.
3. Access to specialty care shall be provided through regularly
scheduled chronic illness clinics and other specialty clinics as
necessary, conducted under the direct supervision of the CHO as
required by Technical Instruction (TI) 15.03.05, Chronic Illness
Clinic.
These clinics are to be operated and care is to be provided in
accordance with the Technical Instruction. Development of
programs that incorporate best practices, prevention strategies,
clinical-practice improvement, clinical interventions and
protocols, outcomes research, information technology, and other
tools is required. The State of Florida has a disease management
initiative which has been designed to promote and measure: health
outcomes, improved care, reduced inpatient hospitalization,
reduced emergency room visits, reduced costs, and better educated
providers and patients. Since these outcomes are similarly
desirous in the correctional healthcare system, the Contractor
shall develop and implement Disease Management programs as
necessary in conjunction with the operation of chronic illness
and specialty clinics. Disease Management programs shall be
completed and implemented by the end of the sixth (6th) month of
service delivery under this Contract.
The Contractor may use, subject to availability, specialty
clinics at the Department's Regional Medical Center (RMC) in Lake
Xxxxxx for all non-emergency cases requiring specialty
consultation that are beyond institutional capability. If a
specialty clinic is not available or can not be scheduled at RMC
within a time determined necessary by the Contractor's CHO,
alternative arrangement to obtain the services shall be made
locally. Additionally, all non-emergency or high risk ambulatory
surgeries may be performed at the mobile surgery unit located at
RMC. Emergencies and high risk cases shall be evaluated by and
treated clinically as determined by the Contractor's CHO in
conjunction with Utilization Management. The Contractor is
financially responsible for all healthcare services provided at
RMC or coordinated through RMC for provision at a community
hospital, as coordinated by the Department's Utilization
Management section.
4. The Contractor shall provide a communicable disease education
program for inmates that is consistent with Procedure 401.012,
the Department's existing health education program for HIV and
AIDS, and that complies with Section 945.35, Florida Statutes.
5. Testing for HIV infection, shall be done in accordance with
applicable State and Federal Law and Department Policies and
Procedures.
6. Infirmary care shall be available for those inmates requiring
skilled nursing care, chronic illness care, convalescent care and
for all acute and chronic conditions that can be managed on-site.
Infirmary care shall be available and is required to be utilized
at all Region IV institutions except Indian River Correctional
Institution. In administering infirmary care, the Contractor
shall ensure the following is provided:
a. When the infirmary is occupied or there is/are inmates shown
as being in an "admitted" status, such as in an IMR cell,
there shall be twenty-four (24) hour coverage maintained
on-site by a Registered Nurse or IV Certified Senior Licensed
Practical Nurse with telephonic capability to contact the
on-call Registered Nurse;
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b. Daily infirmary rounds by nursing staff;
c. 24-hour Physician on-call coverage;
d. A manual of nursing care procedures;
e. A separate and complete medical record for each patient;
f. That infirmary rounds will be conducted by the Physician no
less than one (1) time per day, Monday through Friday; and
g. Contractor staff is within sight or sound of the infirmary at
all times.
7. Documentation shall be made in the inmate's medical record of
all infirmary encounters by a medical services provider working
for, or on behalf of, the Contractor.
8. Contractor shall monitor all infirmary cases to ensure that
inmates who meet generally accepted standards for hospital
admission are not inappropriately maintained in the infirmary.
9. Referral of inmates shall be in compliance with the Department's
utilization management program procedures and such referrals
shall be made to an approved healthcare provider within the
community. Any healthcare subcontracting arrangements must be
approved by the Department. Any hospital facility must also be
approved by the Department to provide hospital-based services
for the Department's inmates as specified in Section II., A. The
Department also has current contractual agreements with
community healthcare providers, generally associated with care
at Reception Medical Center (RMC) (A list of current Department
community healthcare providers is provided for reference as
EXHIBIT A.) The Contractor shall be financially responsible for
all costs associated with the care of an inmate treated by any
community provider or in any community provider facility. Use of
additional Contractor utilization procedures is permitted only
in addition to the Department's utilization management
procedures and only where Contractor's procedures do not
conflict.
10. Hospitalization of inmates requiring care beyond the capability
of the infirmary shall be provided at either a community
provider facility licensed to provide inpatient hospital
services or at the RMC Hospital. Inpatient hospital services are
those medically necessary services provided under the direction
of a physician or dentist in a hospital maintained primarily for
the care and treatment of admitted patients with disorders other
than mental diseases. These services include, but are not
limited to, medical supplies, diagnostic and therapeutic
services, use of facilities, pharmaceuticals, room and board,
nursing care and all supplies and equipment necessary to provide
a minimum constitutionally adequate level of care. Routine
admission from the institution shall be made to a facility
approved by the Department and shall be reported to the
Department's Utilization Management Program at RMC within twelve
(12) hours of occurrence. Recommendations for hospitalization,
with the exception of emergency situations, shall require review
and approval by the Contractor's on-site CHO. Hospital
admissions that arise from emergency situations shall be
reviewed by the Contractor's on-site CHO within forty-eight (48)
hours of admission and reported to the Department's Utilization
Management Program within 12 hours of occurrence.
11. Non-routine (emergency or urgent) or Emergency Medical Services
(EMS) transportation of inmates, as outlined in Section II., A.,
is the responsibility of the Contractor. Routine transportation
of inmates for medical visits, consultations, diagnostic studies
and hospital admissions that utilize Department of Corrections'
vehicles and staff shall remain the responsibility of the
Department.
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12. Contractor shall review the healthcare status of those inmates
admitted to outside hospitals to ensure that the admission is
medically necessary, and the length of stay appropriate as
required by the Department' Utilization Management Program.
13. Compliance with the Department's Utilization Management Policies
and Procedures regarding referral methods, scheduling,
transportation, reporting of test results, healthcare records,
acute care hospitalization and patient follow-up is required.
The Contractor may utilize its own Utilization Management
Procedures where such procedures do not conflict with the
Department's.
14. Treatment, care or procedures, including but not limited to,
surgery and prosthetics, initiated at the institution, shall be
completed prior to clearance of the inmate for transfer to
another institution with the exception of emergency,
disciplinary or mental health transfers. If an inmate is
transferred prior to completion of treatment, the financial
burden for the provision of completing appropriate care is the
responsibility of the Contractor and will be billed back to the
Contractor by the Department or will be the responsibility of
the state-operated facility originally providing the service.
15. Referral of inmates requiring hospitalization or other specialty
care in continuing follow-up to previous surgery or other
scheduled procedures remains the responsibility of the
Contractor or state-operated facility originally providing the
service.
16. Contractor shall perform eye examinations on-site in accordance
with ACA Standards and TI 15.02.10 and TI 15.03.05. A qualified
Optometrist shall examine inmates with specific complaints.
17. Ophthalmic prosthetics clinically mandated by an Ophthalmologist
and services (including prosthetics) necessary to the continued
provision of needed healthcare for the inmate shall be the
responsibility of the Contractor. Non-clinically mandated
ophthalmic prosthetics may be provided at the inmate's expense.
Eyeglasses shall be obtained by the Contractor, through PRIDE.
L. Mental Healthcare Services
1. General Overview
The Contractor shall provide and be financially responsible for
all mental healthcare services necessary to carry out the
following service tasks:
a. Identification of those inmates experiencing disabling
symptoms of adjustment, mental disorder and/or mental
retardation impairing the inmate's ability to function
adequately within the general inmate population.
b. Alleviation of disabling symptoms of mental disorders.
c. Assisting the inmate to adjust to the demands of prison life.
d. Assisting the inmate with mental disorder or mental
retardation to maintain a level of personal and social
functioning that will enable him/her to remain in or be
returned to the general inmate population.
e. Provision of clinically necessary and appropriate mental
health inpatient care.
All mental healthcare shall be provided in such a manner as to
maintain the dignity of the inmate and afford him or her a
reasonable degree of privacy.
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2. Levels of Care to be Provided
a. Outpatient
This refers to services provided to an inmate housed in the
general population at all institutions as distinct from a more
specialized inpatient unit. Outpatient mental healthcare
services include, but are not limited to, individualized
service planning, proactive case management, group and/or
individual counseling, along with periodic psychiatric
monitoring and/or treatment as determined necessary.
b. Isolation (Crisis Management)
This level of care is provided at most institutions and
includes all behavioral and/or psychiatric emergencies such as
management of the suicidal or decompensating inmate. Crisis
management may require placement in an infirmary Isolation
Management Room (IMR) or other specifically designated safe
housing at a permanent institution for rapid assessment, close
observation, and institutional based intervention. The lengths
of stay in an IMR or alternative housing are specified in HSB
15.05.05 and Procedure 404.001 Suicide and Self-Injury
Protection. The crisis may be appropriately managed at this
level or may require referral and subsequent transfer to a
Crisis Stabilization Unit (CSU). IMR's and Observation Cells,
when indicated, are designed to provide a safe and appropriate
setting for initial housing and observation of inmates who
present impairment that cannot be managed within the general
inmate population.
c. Transitional (Intermediate and/or Chronic)
Transitional Care is only available at designated institutions
and is delivered in the Transitional Care Unit (TCU). The TCU
is a low-stress, residential placement with a therapeutic
milieu and direct treatment components. It is designed to
provide evaluation, treatment, and mental healthcare
intervention to any inmate whose symptoms of serious mental
disorder interfere with his/her capacity to safely adapt in a
general inmate population setting or special housing setting.
The goal is to alleviate problems and improve functioning
sufficiently to return the individual to the least restrictive
clinical and custodial environment. Long-term residence in the
TCU will be considered for an inmate who suffers from a
chronic, severe, and persistent mental illness (and the
inability to readjust to the general population or special
housing).
Some chronically impaired inmates may remain in transitional
care for extended periods of time. For example, mentally
retarded inmates who cannot function in open population, may
remain in transitional care for the duration of incarceration,
if warranted.
Additionally, transitional mental healthcare is indicated for
a person with chronic or residual symptomatology who does not
require crisis stabilization care or acute psychiatric care at
the hospital level, but whose impairments in functioning
nevertheless render the inmate incapable of adjusting
satisfactorily within the general or special housing inmate
population even with the assistance of outpatient care.
d. Crisis Stabilization (Brief Inpatient)
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Crisis Stabilization is a more intensive level of care that
allows for closer management, observation, and treatment
intervention while seeking rapid stabilization of acute
symptoms and conditions. This level of care is provided in a
Crisis Stabilization Unit (CSU) which is a locked, highly
structured, safe environment located within select major
institutions.
CSU programs include a broad range of evaluation and treatment
services intended for inmates who are experiencing acute
emotional distress and who cannot be adequately evaluated and
treated in a TCU or infirmary IMR. Inmates who are assigned to
CSU's generally remain within the locked inpatient unit and do
not access services and activities available to general
population inmates. Crisis care is only intended for very
short term periods.
e. Acute Psychiatric Inpatient Care
This level of treatment is the highest level of mental
healthcare available to inmates and can only be provided
through court order. Acute psychiatric care requires prior
judicial commitment to the facility, except for admissions of
an emergent nature. Inmates referred on an emergency basis
will receive judicial review and commitment (if indicated)
following evaluation at admission. Acute Psychiatric Inpatient
Care includes a broad range of evaluation and treatment
services within a highly structured, secure and locked
hospital setting. Patients are typically chronically and/or
severely impaired and do not respond favorably to brief
inpatient and/or intermediate care. Patients are typically
discharged to TCUs for further treatment and progressive
reintegration to a suitable incarcerative environment.
3. Mental Health Screening at Reception Centers
a. The Contractor shall provide to all newly committed inmates
upon receipt at a Department reception center a mental health
screening including psychological testing, clinical interview,
and mental health history. Those inmates presenting with acute
symptomatology of an Axis I disorder are referred for
immediate psychiatric evaluation, except acute substance abuse
cases that are referred to medical staff for detoxification.
These inmates are seen by a psychiatrist within the timeframes
specified in HSB 15.05.17.
b. The Department of Corrections utilizes a health profiling
system, which includes mental health classification. This
profiling system assigns an S-grade to each inmate based on
the inmate's ability to function in various correctional
settings. The S-grade shall be assigned at reception and
represents the mental health professional's assessment
regarding the inmate's potential or actual ability to adapt
and adjust successfully to the prison environment.
c. Since the mental health program is designed to provide varying
levels of care at different facilities, the assigned S-grade
in part will determine to which facility the offender may be
transferred. Other determinants include the inmate's custody
or security level, program needs, medical limitations, and
potential for aggressive behavior.
d. The S-grade will be assigned as follows:
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1) S-1 = Inmate requires routine care or emergency care.
2) S-2 = Inmate needs ongoing services of outpatient
psychology.
3) S-3 = Inmate needs ongoing services of outpatient
psychology and outpatient psychiatry. S-3 is also assigned
routinely to an inmate who is determined to need
psychotropic medication, even if the inmate may be
exercising the right to refuse such medication.
4) S-4 = Inmate is assigned to a Transitional Care Unit (TCU)
level of care.
5) S-5 = Inmate is assigned to a Crisis Stabilization Unit
(CSU) level of care.
6) S-6 = Inmate is assigned to acute psychiatric inpatient
care at the Corrections Mental Health Institution units
(CMHI units).
7) S-9 = Inmate is in the reception process and is scheduled
to be evaluated by a psychiatrist. This does not include
inmates under the care of a psychiatrist at the time of
commitment to the Department who are classified as S-3 or
higher until evaluated by a reception center psychiatrist.
4. Inmate Orientation to Mental Health Services
The Contractor shall orient all newly arriving inmates to mental
health services at the receiving institution within the time
frame specified in TI 15.05.18.
Orientation shall consist of a written, easily understood
explanation (available both in English and Spanish) and oral
presentation of available services and instruction on accessing
mental health services including consent or refusal of mental
health services and confidentiality. Such orientation shall be
documented on Form DC4-773 Inmate Health Education (see TI
15.01.06). Such documentation may be included in a clinical
encounter, if such encounter was held, as in the case of S-2
level and above screening.
5. S-Grade, Health Record Review and Assessment for Continuing Care
All newly arriving inmates who are classified as S-2 shall
undergo a psychological screening within the time frame and
guidelines specified in TI 15.05.18 to assess current functioning
and treatment needs.
All newly arriving inmates who are classified as S-3 shall
undergo a psychiatric update within the time frame specified in
TI 15.05.18 to assess mental status and update the Individualized
Services Plan (ISP). Medical staff shall ensure continuity of
pharmacotherapy for any newly arriving S-3 inmate until such time
as the inmate can be interviewed by a psychiatrist. If the inmate
does not have a psychiatric evaluation completed within the
Department, or if psychotropic medication is initiated on an
outpatient basis, the Form DC4-655 Psychiatric Evaluation shall
be completed per TI 15.05.18. Medical and/or mental health
nursing staff shall ensure continuity of psychotropic medications
immediately upon the inmate's arrival.
All newly arriving inmates whose mental health screenings
indicate the need for inpatient care (S-9) will be seen
immediately by a psychiatrist for determination placement and
care.
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6. Case Manager Assignment and Screening for S-2 and S-3 Inmates
All newly arriving S-2 and S-3 inmates shall have a case manager
assigned (with documentation in the health record) and shall be
interviewed within the time frames specified in HSB 15.05.11 by a
psychologist, psychological specialist, or RN Specialist. The
interview will include a mental status examination and review of
the status of problems that were the focus of attention prior to
arrival. In the case of an inmate who is recently downgraded from
an S-3 and above classification that is reassigned to an S-1 or
S-2 institution, the inmate shall be maintained as S-2 for a
period of two months and provided services accordingly.
7. Record Review for all X-0, X-0, and S-3 Inmates
All mental health sections of records for newly arriving inmates,
regardless of "S" grade level, whether received from a reception
center or transferred from another institution, must be reviewed
within 8 days of arrival by the Contractor's mental health
service providers.
The purposes of the record review are to:
a. assess and prioritize treatment needs;
b. review the health record of every new arrival within the time
specified in TI 15.05.18 to determine the suitability of the
S-grade and to determine whether further evaluation and/or
treatment is indicated; and
c. document the record review as an incidental note, summarize
the relevant history (education, marital status, work history,
physical health, drug/alcohol use, suicide threats/attempts,
and mental health treatment before and since incarceration),
and initiate the follow-up actions required at the new
institution, (e.g., "needs sexual disorder screening",
"referral to special education", "referral to substance abuse
treatment program", or "clinical interview due to S-2 grade").
8. Ongoing Mental Health Services:
a. Service Eligibility
The conditions for inmate eligibility for ongoing mental
health treatment and services are established in TI 15.05.18.
Ongoing mental healthcare (e.g., group and individual therapy,
case management, and psychopharmacotherapy) shall be reserved
for inmates who have or are at significant risk for developing
one or more of the clinical syndromes listed in TI 15.05.18
(DSM IV-TR Axis I disorders, mental retardation, borderline
personality disorder, and schizotypal personality disorder).
b. Case Management
Case management services shall be provided to all S-2 and S-3
inmates who are receiving ongoing mental health services. Case
management is used to describe a wide variety of actions that
the case manager performs and should be identified on the
Individualized Service Plan just as with other interventions,
(e.g., individual or
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group therapy). Case Management is a service, not a
treatment, for an identified problem. The Contractor shall
ensure the frequency of delivery of case management services
as indicated in TI 15.05.18.
All inmates who are returned to the general population from
isolation management, transitional care, or crisis
stabilization shall receive case management and appropriate
follow-up services in accordance with the individual
assessment of clinical need.
The case manager shall also complete or update the Form
DC4-643C Bio-Psychosocial Assessment and shall ensure that
the Individualized Service Plan is updated in accordance with
time frames specified in TI 15.05.05 (for inpatients) or TI
15.05.11 (for outpatients).
If the bio-psychosocial assessment (BPSA) is incomplete or
outdated, (more than 12 months since the last revision), it
must be completed/updated.
c. Psychotherapy/Counseling
Psychotherapy is considered an interactive intervention
between the clinician and the patient, while case management
essentially focuses on service monitoring and progress
assessment. While group therapy is more time and cost
efficient, the inmate's identified clinical needs will
ultimately determine the type and frequency of the therapy
modality. The Contractor shall deliver whatever therapy
modality will best meet the inmates' identified clinical
needs.
9. Consent to Mental Health Evaluation and Treatment
Express and informed consent means consent voluntarily given in
writing after provision of a conscientious and sufficient
explanation.
All inmates undergoing treatment and/or evaluation, including
confinement assessments and new screenings, must have a valid
Form DC4-663 Consent to Mental Health Evaluation or Treatment
(see TI 15.05.18) executed within the past year. Contractor's
staff shall advise inmates of the limits of confidentiality
prior to delivery of any mental health services.
Consent for phannacotherapy is described in TI 15.05.06 and
shall be routinely completed by psychiatry staff. Fully informed
consent for pharmacological intervention must be obtained by the
psychiatrist prior to the initiation of such intervention.
10. Refusal of Mental Health Services
All inmates presenting for mental health services shall be
informed of their right to refuse such services, unless services
are to be delivered pursuant to a court order. If an inmate
refuses treatment that is deemed necessary for his/her
appropriate care and safety, such treatment may be provided
without consent only under the following circumstances:
a. In an emergency situation in which there is immediate danger
to the health and safety of the inmate or other inmates. Such
treatment may be provided at any major
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institution. Emergency Treatment Orders (ETO) shall be issued
as indicated in HSB 15.05.19.
b. Involuntary treatment, likely to extend beyond forty eight
(48) hours, may only be sought for inmate patients committed
for treatment at a CMHI unit. The criteria for court petition
for involuntary treatment at a CMHI unit are based on Section
945.43 Florida Statutes and Florida Administrative Code,
Chapters 33-23 and 33-40.
c. If an inmate is unable to give express consent to mental
health treatment and, in the professional judgment of the
mental healthcare provider, such treatment is immediately
necessary to preserve the inmate's welfare, emergency mental
health treatment may be rendered.
When an inmate refuses mental healthcare services, such refusal
shall be documented in the inmate health record. Refusals of
mental health evaluation/treatment shall be documented on Form
DC4-711A Refusal of Healthcare Services Affidavit which should
be filed under the Mental Health Authorizations and Consents
subdivider. If the inmate refuses to sign Form DC4-711A, the
form shall be completed and signed by the provider and another
staff member who witnessed the refusal. This shall then be filed
on the right side of the health record behind the Mental Health
Authorizations/Consents/Refusals subdivider.
11. Confidentiality
The limits of confidentiality are delineated on Form DC4-663
Consent to Mental Health Evaluation or Treatment. The Contractor
shall ensure that mental health staff is aware and understands
these limits before undertaking evaluation or treatment and that
the inmate has also been made aware of and understands these
limits.
Requests from outside organizations for mental health-related
information about inmates will be referred to the institution's
Health Information Specialist. Release of any confidential
health records must be accompanied by Form DC4-711B Consent for
Inspection and/or Release of Confidential Information (signed by
the inmate and notarized). Psychological evaluations completed
for the Florida Parole Commission also require a signed inmate
consent.
Disclosures that are made by an inmate to a healthcare
professional while receiving mental health services shall be
considered confidential and privileged, except for the
following:
a. Threats to physically harm self and others.
b. Threats to escape or otherwise disrupt or breach the security
of the institution.
c. Information about an identifiable minor child or
elderly/disabled person who has been the victim of physical
or sexual abuse.
All information obtained by a mental healthcare provider shall
retain its confidential status unless the inmate specifically
consents to its disclosure by initialing the appropriate areas
listed on the Form DC4-711B. (For example, if an inmate is
undergoing a psychological evaluation for the Florida Parole
Commission and is found to have a coexisting AIDS-related
syndrome, be it related or not to his/her mental condition, no
mention of his/her AIDS condition should be made in the
psychological
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report unless the inmate expressly authorizes such disclosure to
be made to the Florida Parole Commission by initialing B option
on DC4-711B.)
When admitted to an IMR, TCU or CSU, mental health staff or (in
their absence) a healthcare professional shall request that the
inmate give written informed consent to treatment. The inmate
may refuse to consent to treatment once in the IMR, however, the
inmate cannot refuse placement.
12. Individualized Service Plan
Each inmate who receives ongoing mental health services shall
have an Individualized Service Plan (ISP) developed in
accordance with HSB 15.05.11 Planning and Implementation of
Individualized Mental Health Services.
13. Clinical Review and Supervision
All non-psychiatric mental health services provided must be
directly supervised by the Senior Psychologist who shall assume
clinical responsibility and professional accountability for the
services provided. In doing so, the Senior Psychologist shall
review and approve reports and test protocols as well as
intervention plans and strategies. Documentation of required
review and approval shall take the form of co-signing all
psychological reports, ISPs, treatment summaries, and referrals
for psychiatric services and clinical consultations.
A minimum of one hour per week shall be devoted to direct
face-to-face clinical supervision with each psychological
specialist and/or in accordance with guidelines of the Chapter
490 and 491 Boards. The supervision shall focus on relevancy of
entries to the existing ISP, progression towards therapy
objectives and ultimate goals, and assistance in any matter that
the psychological specialist may elect to bring to supervision.
Documentation of the supervision taking place must be maintained
in the mental health services unit. Confidentiality over topics
discussed shall be maintained to the extent that it shall not be
in conflict with the safety and security of the inmate being
reviewed or the safety and security of anyone else. Additional
time for supervision is at the discretion of the Senior
Psychologist based on the needs of the psychological
specialists.
All group treatments must have written descriptions that have
been reviewed and approved by the Senior Psychologist. The group
descriptions shall include purpose, participating inmates,
goals, predominant therapeutic approach, curriculum outline, and
inmate selection criteria. If the group has a waiting list, then
the selection criteria must include means of prioritizing
enrollment.
14. Confinement Inmates
Mental health staff shall track the stay of inmates in
confinement so that each can be evaluated within required time
frames in compliance with TI 15.05.08.
a. Inmates in Confinement Settings
Mental health staff shall perform rounds in each confinement
unit on a weekly basis, to personally observe each inmate,
and to inquire as to whether the inmate has any mental
health-related problems. The observation and inquiry can be
performed at
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the cell front, as the purpose of the encounter is not to
perform in-depth assessment, but rather to determine whether
an appointment should be made to do so. If problems or
concerns are cited by the inmate or observed by the
clinician, an appointment shall be scheduled for timely
follow-up.
Documentation for inmates in confinement settings shall be as
follows:
1) Mental health staff will enter the outcome of rounds for
each inmate utilizing the following code format on the
Form DC6-229 Daily Record of Segregation so as to avoid
any breach in confidentiality:
a) Code MH-1 (refer to medical for follow-up of physical
health-related complaint)
b) Code MH-2 (immediate mental healthcare services needed
due to urgent or emergent concerns)
c) Code MH-3 (no action required)
d) Code MH-4 (schedule for non-emergent follow-up by
mental health care staff)
e) Code MH-5 (evaluation and/or treatment)
2) If a code other than MH-3 is entered on the Form DC6-229
Daily Record of Segregation, mental health staff shall
also make appropriate charting in the health record on the
Form DC4-642 Chronological Record of Outpatient Mental
Healthcare. A copy of each written referral will be placed
in the health record under the Other Mental Health Related
Correspondence subdivides
b. Confinement Assessment
Confinement assessments shall include a mental status
examination and any other formal evaluation needed to
determine the inmate's suitability for continued confinement.
Because of confidentiality issues, psychiatric or
psychological confinement assessments must never be conducted
at the cell front.
The Mental health grades shall be evaluated as follows:
1) S-1 and S-2 inmates must be evaluated within 30 days after
being placed in confinement and every 90 days thereafter.
2) S-3 inmates are required to have a mental status
examination recorded on the Form DC4-642 within five (5)
days of being placed in confinement and every 30 days
thereafter. Since S-3 inmates are seen at least every 30
days as part of the treatment plan, this evaluation can be
done as part of the regular case management contact.
Mental health staff shall notify the classification
supervisor of each inmate's mental condition as these
confinement assessments are completed using Form DC4-528
Mental Status of Confinement Inmates. Notification shall
indicate that the inmate is either unimpaired, receiving
appropriate outpatient care, or has been referred for
inpatient care. A copy of the completed DC4-528 shall be
placed in the health record (Other Mental Health Related
Correspondence subdivider).
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All facilities shall use OBIS to track inmates in
confinement. The OBIS printout indicates when all confinement
reviews are to be scheduled and will indicate any
discrepancies.
c. Treatment While in Confinement
The Contractor shall ensure that confined inmates receive all
necessary and appropriate mental healthcare including
evaluation, case management, individual therapy, group
therapy, and psychotropic medication. Mental healthcare shall
be provided in the confinement interview room when possible.
The Contractor shall comply with the procedural elements as
detailed in TI 15.05.08 Mental Health Services for Inmates
Who Are Assigned to Confinement, Protective Management or
Close Management Status.
15. Outpatient Psychiatric Consultation for Inmates at S-1 or S-2
Institutions
Outpatient psychiatric consultation is indicated when any of the
following occurs: (in absence of condition which would warrant
referral to a crisis stabilization unit)
a. When staff cannot reach a definitive diagnosis of presenting
symptoms that impair functioning or are unsure about the
possible risk of serious harm. (For example, where a patient
who has had multiple episodes of suicidal ideation and/or
minor self-injury may require psychiatric evaluation as part
of the follow-up after being returned to general population
from infirmary isolation.)
b. Presenting symptoms are accompanied by more than mild (i.e.,
at least moderate) impairment of functioning.
c. Presenting symptoms, though accompanied by only mild
impairment of functioning, persist after appropriate
psychological intervention has been provided. (For example,
where an inmate with mild depression or anxiety has not
responded to two to six (2-6) months of verbal therapy.)
d. Presenting symptoms suggest the presence of a major mental
illness such as dementia or other cognitive disorder, mood
disorder, or psychotic disorder.
Outpatient psychiatric consultation is obtained through
transport versus transfer of the inmate to the nearest S-3
facility. The inmate is returned the same day of the consult,
unless the psychiatrist determines that immediate admission to a
CSU is indicated. The Regional Mental Health Consultant will
designate the preferred consulting facility for each particular
institution.
Outpatient psychiatric consultation may be requested by a
physician or Senior Psychologist. The Senior Psychologist or
physician, in that order of availability, must give prior
approval of any psychiatric consultation that is recommended by
a psychological specialist.
16. Referral/Transfer to TCU/CSU/CMHI Units
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Transfer criteria and procedures are fully described in
Procedure 404.003 Mental Health Transfers.
ALL TRANSFERS SHALL BE COORDINATED WITH THE DEPARTMENT'S OHS
TRANSFER COORDINATOR IN THE OFFICE OF HEALTH SERVICES.
Mental health transfers for inpatient care to TCUs, CSUs, and
CMHI units shall be considered either routine, urgent, or
emergent (based upon clinical assessment made by the referring
mental health team). All TCU referrals are routine transfers
while CSU referrals, by nature, will be considered as urgent or
emergent. CMHI unit referrals are either routine or emergent.
During regular working hours, transfers shall be effected by
completion of the Form DC4-656 Referral for Inpatient Mental
Healthcare (the designated e-form shall be utilized) which shall
be directed to the population management administrator and to
the mental health transfer coordinator.
After regular working hours (and on weekends and holidays),
transfers shall be effected by on-site medical staff who shall
intervene to manage any mental health emergency according to the
protocol established in Procedure 404.003.
a. Corrections Mental Health Institution (CMHI) Transfers
Routine transfers to CMHI shall be initiated through a
consensus reached by a CSU multidisciplinary service team
which will request the institutional warden to file a
petition with the court in the county where the inmate is
housed.
Emergent transfers to CMHI units are indicated through
consensus reached among the CSU multidisciplinary services
team that a patient's condition has reached a level of care
that cannot be provided at the institution and that only CMHI
can provide the required level of care. The staff
psychiatrist or the unit coordinator shall advise the warden
who will need to give administrative approval of the
emergency transfer request. Once warden approval is granted,
the Contractor shall contact the Regional Mental Health
Consultant of that region who must give approval based on
his/her appraisal of the inmate's clinical condition.
17. Suicide Prevention and Crisis Management
The Contractor shall comply with Department Procedure 404.001
with regard to the care and management of inmate's at risk for
self-harm.
a. Department staff have been trained to recognize and
immediately report warning signs for those inmates exhibiting
self-injurious behavior and suicidal ideations. However, only
the Contractor's mental health or medical staff will
determine risk of self-injurious behavior, assign/discontinue
suicide observation status, and make other decisions that
significantly impact healthcare delivery, such as when to
admit/discharge from a given level of care.
b. A psychiatrist, Psychiatric Advance Registered Nurse
Practitioner (ARNP), psychiatric clinical associate or
psychiatric physician assistant shall have final
responsibility and authority for the clinical management of
inmates assessed as at- risk for serious self-injurious
behavior or suicide, in the absence of a psychiatrist,
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Psychiatric ARNP, psychiatric clinical associate or
psychiatric physician's assistant, a non-psychiatric
physician, or regular ARNP clinical associate or physician's
assistant will assume final responsibility and authority for
clinical management, in consultation with available mental
health staff (typically, psychological specialists and
psychologists). Additionally, the non-psychiatric physician,
clinical associate or physician's assistant, may consult with
a psychiatrist via telephone, at his/her discretion.
c. The assignment (ordering) of suicide observation status will
require prior admission to one (1) of the following levels of
mental health care:
1) infirmary mental health care;
2) transitional care;
3) crisis stabilization care; and
4) acute hospital care (Corrections Mental Health Institution
Units).
d. All initial orders for suicide observation status shall
address:
1) Observation Frequency: The inmate-patient will be observed
every fifteen (15) minutes or continuously, depending upon
her/his acuity level.
a) Generally, it is appropriate that inmates who are
judged suicidal are observed continuously, while those
with less acuity may be observed at least every fifteen
(15) minutes.
b) The frequency of observation will be continuous when an
isolation management room or observation cell is not
available (i.e., inmate is being housed outside of an
isolation management room or observation cell for up to
seventy-two (72) hours) or when the inmate is outside
of the available isolation management room or
observation cell.
2) Housing: Inmates will be housed in an isolation management
room. If an isolation management room is not immediately
available on site, the inmate may be housed in an
observation cell in accordance with the following:
a) The use of an observation cell when an isolation
management room is not immediately available at the
institution of residence will only occur for the
purpose of providing safe, temporary housing of an
inmate, until such time as the inmate can be evaluated
by mental health staff (Psychiatric ARNP, psychological
specialist, senior psychologist, or psychiatrist). Such
use of an observation cell will not exceed seventy-two
(72) hours.
b) The use of an observation cell for the above-stated
purpose shall require admission to infirmary mental
health care and prior nursing assessment recorded on
"Mental Health Emergency Nursing Assessment," DC4-683A,
and a physician's order, typically given over the
telephone. The physician's order shall specify the
interval of observation required (typically, "q-15
minutes"); diet/eating utensil restrictions, if any;
and permissible apparel (typically, isolation blanket,
mattress, and privacy wrap). Security staff will
observe the inmate, and will record such observation on
the "Observation Checklist," DC4-650. Nursing staff
shall perform evaluation of the inmate each shift as
per established protocol.
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c) Mental health staff will evaluate the inmate in the
morning of the next work day, and will make one of the
following recommendations/dispositions, in the order
presented, as appropriate:
(1) Release the inmate to general inmate housing (which
includes open population and/or confinement).
(2) Initiate formal infirmary admission and move the
inmate to the institutional infirmary or other
healthcare (non-confinement) area. Any placement of
an inmate outside of an isolation management room
will require continuous one-to-one observation,
with documentation every fifteen (15) minutes on
the "Observation Checklist," DC4-650, performed by
security staff.
(3) Place the inmate in an open transitional care
unit/crisis stabilization unit cell (for
institutions having such units), albeit such
placement will not constitute an admission to
transitional care unit/crisis stabilization unit,
and the inmate will have to be moved if the bed is
subsequently needed for a transitional care
unit/crisis stabilization unit admission.
(4) Transfer the inmate to an institution having an
available Isolation Management Room (IMR), pursuant
to "Mental Health Transfers," Procedure 404.003. In
this regard, each institution will maintain a list
of institutions in relatively close proximity to
which an inmate may be transferred for admission to
an IMR. Such transfer and admission shall be
temporary, and the inmate will be returned to the
sending institution if and when an IMR becomes
available, provided that the inmate has not already
been discharged to general population housing (at
the sending institution) or admitted to a crisis
stabilization unit.
d) In the event that a suitable bed is not available at
the institution of residence for an inmate who has been
assessed by mental health staff as requiring inpatient
mental health treatment, the warden, security, and
healthcare staff will work collaboratively to determine
the safest alternative housing available, until the
inpatient bed is available.
e) A general infirmary bed will not be used as an
alternative location for close management or other
inmates who pose imminent security risk.
f) Before an inmate is transferred for IMR placement,
institutional staff will maximize utilization of
available space. For example, general population
inmates who are housed in IMR's may be reassigned to
suitable alternative housing in a healthcare setting
(e.g., respiratory observation room or general
infirmary bed) in order to make IMR's available to
close management or other high security inmates.
3) Diet/Eating Utensils: The "crisis stabilization diet" and
associated utensils specified in "Prescribed Therapeutic
Diets," Procedure 401.009, shall be used, unless otherwise
ordered and justified in the record, by the attending
clinician.
4) Approved Mattresses, Blankets, and Privacy Apparel: Only
those mattresses, blankets, and privacy apparel that meet
the standards in "Isolation Management Rooms and
Observation Cells," Procedure 404.002, will be given to
inmates who are on suicide observation status.
5) Standard Issue Apparel/Supplies for Inmates Assigned to
Suicide Observation Status: The following shall be issued
to each inmate assigned to suicide observation status,
unless explicitly denied by attending clinician's written
order, in which case, such order will include written
clinical justification: (Under no
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circumstances will an inmate be left without a means to
cover her/his nakedness).
a) canvas or other tear-resistant blanket;
b) canvas or other tear-resistant privacy wrap;
c) paper or canvas or other tear-resistant gown (for
females only);
d) plastic covered mattress; or
e) underpants (for females only).
6) Clothing While Attending Activities Outside of the
Isolation Management Room/Observation Cell: Regular xxxx
clothing shall be issued when the inmate-patient is
allowed to attend activities outside of the
IMR/observation cell, unless prohibited by order of the
attending clinician, who will provide clinical
justification for such restriction, and specify
alternative clothing to be worn, in the infirmary record.
Suicide observation status shall be reordered by the attending
clinician every twenty-four (24) hours. During weekends and
holidays, this may be accomplished via verbal order, which shall
be countersigned by a physician, advance registered nurse
practitioner (ARNP), or clinical associate within ninety-six
(96) hours.
18. Time-Out, Seclusion and Restraint
Departmental policy allows for the use of time-out, seclusion,
and/or therapeutic restraints with appropriate clinical
justification to manage crises and prevent suicides. Usage shall
be in accordance with appropriate laws and professional
standards. The least restrictive alternative is to be used to
help the inmate regain self-control when such action can
reasonably be expected to be effective. These procedures shall
never be used as punishment, but rather to protect the emotional
well being of the inmate as well as the safety of the inmate and
others. Refer to TI 15.05.10 Use of Time-Out, Psychiatric
Seclusion, and Psychiatric Restraints.
19. Use of Force with Mentally Disordered Inmates
Physical force may be used with a mentally disordered inmate
only as a last resort when it reasonably appears that other less
restrictive and intrusive alternatives are not feasible. When
the use of physical force is indicated, only that amount and
type of force necessary to accomplish the authorized objective
shall be employed. If necessary, an electronic restraining
device(s) may be used to move the inmate to a CSU or an IMR.
Chemical agents such as pepper spray shall not be used in
inpatient mental health settings such as IMR's TCU's, CSU's, or
the Corrections Mental Health Institution unit, except where
reasonably necessary in order to:
a. Prevent or subdue an inmate or inmates from taking control of
the health unit.
b. Prevent an inmate from taking a hostage or to help free a
hostage.
c. Prevent an inmate from escaping.
The use of physical force may be appropriate under the following
circumstances:
a. To administer court-ordered treatment or treatment that is
necessary to protect the health of other persons, or to
protect the inmate against self-inflicted injury or death
(only by or under the order and supervision of a physician or
designee).
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b. To reduce the threat of immediate physical harm to property,
inmate patients, or staff at the hands of an inmate patient
who is displaying verbal or physical aggression.
c. To facilitate compliance with a lawful command which is
necessary to maintain order and security within the unit.
Documentation of a use-of-force and its authorization shall be
made pursuant to Chapter 33-3.0066, Florida Administrative Code.
Refer to Procedure 602.002 Use of Force in Correctional
Facilities.
20. Screening, Treatment, and Continuity of Care for Sex Offenders
Sex offender screening shall be completed within thirty (30)
days of arrival at a permanent institution. If the inmate
refuses or is not amenable to treatment for a diagnosed sexual
disorder, (excluding disorders of sexual dysfunction) the
refusal shall be documented through a signed refusal form and
filed in the inmate's health record. All effort should be made
to enroll eligible inmates in the program once the inmate is
within two years of his/her projected release date. Treatment
prior to that time would be considered premature intervention
since the primary goal is to prepare the inmate for continued
treatment within the community upon release. Screening and
treatment of sex offenders shall be in compliance with HSB
15.05.03.
Mental health staff shall recommend treatment only for those
inmates who show evidence of a diagnosable sexual disorder and
who are amenable to treatment. Inmates appropriate for treatment
will be those who admit to having engaged in obsessive deviant
sexual fantasy or illegal/harmful behavior in the past, express
a desire to alleviate or avoid such fantasy or behavior in the
future, and are willing to participate in available treatment
before release.
Prior to group enrollment, mental health staff shall ensure that
the DC4-663, Consent to Mental Health Evaluation or Treatment is
current within the past 12 months. In addition, inmates with
paraphilic sexual disorders shall be requested to sign a
DC4-660, Consent to Sex Offender Treatment.
Civil commitment: The Xxxxx Xxxx Sexually Dangerous Predators
Act requires the identification of inmates who may be assessed
as sexual predators prior to their release from the Department.
Records, including assessment and treatment (if any), and
institutional adjustment data for these inmates shall be
forwarded by the institutional Health Information Specialist
(HIS) to a multidisciplinary team of mental health professionals
with the Department of Children and Families (DCF) for further
review and assessment in compliance with Department Procedure
Manual 601.213, Civil Commitment of Sexually Violent Predators.
21. Mentally Retarded Inmates
Mentally retarded inmates with minimal to mild impairment in
ability to function within the general inmate population are
assigned to institutions having impaired inmate services. Those
with moderate impairment in functioning may be referred and
assigned to a TCU.
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Mental health staff shall keep track of all mentally retarded
inmates so that continuity of care procedures can be undertaken
at least 180 days before release (see TI 15.05.18). Mental
health services for inmates identified as mentally retarded will
be provided in accordance with TI 15.03.25., Impaired Inmate
Services.
22. Aftercare Planning for Mentally Retarded and Mentally Disordered
Inmates:
a. Post-incarceration Inpatient Referral Planning
Inmates who reach end-of-sentence and who continue to suffer
from a mental illness and present a danger to self or others
may require inpatient care after release from the Department.
When appropriate, the Contractor's staff shall initiate Xxxxx
Act (judicial commitment) proceedings prior to the inmate's
release. Xxxxx Act proceedings may only be initiated at CMHI
units or a CSU. Where appropriate, mental healthcare staff at
other facilities shall immediately transfer patients who
require inpatient care and are approaching end-of-sentence
(EOS) to a CSU. The inpatient units shall pursue civil
commitment to a mental health receiving facility in
accordance with HSB/TI 15.05.18.
b. For Mentally Retarded Inmates:
The required procedure to be followed by Contractor's staff
in aftercare planning for mentally retarded inmates who will
need outpatient care is as follows:
A continuity of care plan shall be developed for each
mentally retarded inmate being released from the Department.
Mental health staff shall track (via OBIS) the expiration of
sentence of such inmates so that aftercare planning can
commence not later than 180 days prior to EOS. Inmates with
mental retardation shall be provided outpatient follow-up
through the Agency for Persons with Disabilities (APD). As
with S-3 inmates, the case manager will initiate referral to
the appropriate APD district program office at least one
hundred fifty (150) days before EOS and provide the
following:
1) Name of the inmate and the community where s/he intends to
reside.
2) Inmate's expected date of release.
3) Qualifying disability pursuant to Chapter 393, Florida
Statute.
The case manager shall ensure that the inmate understands how
to apply for services and assists him/her in applying.
c. For Mentally Disordered Inmates:
The required procedure to be followed by Contractor's staff
in aftercare planning for mentally disordered (versus
mentally retarded) inmates who will need outpatient care is
as follows:
1) Contact the Department of Children and Families' District
Forensic Coordinator (see list in TI 15.05.18) to
coordinate aftercare planning with the community mental
health center that will provide services to the inmate
after release.
2) Obtain a signed release of information form from the
inmate to the District Forensic Coordinator and the
appropriate community facility. Forward the
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Referral for Mental Health Aftercare Planning to the
District Forensic Coordinator.
3) Document all contacts as incidental notes on the DC4-642,
Chronological Record of Outpatient Mental Healthcare and
file correspondence in the Other Mental Health
Related Correspondence section of the health record.
4) Inform the inmate of his/her appointment verbally and in
writing, and send a treatment summary to the community
facility thirty (30) days prior to EOS.
Contractor shall comply with TI 15.05.18 in providing
aftercare planning for mentally disordered inmates.
23. Psychological Evaluations and Referrals
Mental health staff shall provide psychological evaluations for
inmates referred by various program areas or by other
correctional entities including the Florida Parole Commission
and the Interstate Compact Office. The techniques used may vary
depending on the nature of the evaluation and the referral
question, but will generally require a record review and
clinical interview (and may require psychological testing).
a. FPC Referrals for Counseling/Therapy:
Referrals for mental health services may be received from the
Florida Parole Commission (FPC) via e-mail to the
Department's Director of Mental Health Services (DMHS), with
a copy to the Director's Administrative Assistant. FPC
referrals will generally request a psychological evaluation
and report or consideration for mental health
counseling/therapy (typically anger/stress management or sex
offender group). Referrals will take place in the following
manner.
1) The DMHS will record the request on the "FPC Request Log",
confirm the location of the inmate, and forward the
request (via e-mail) to the Senior Psychologist (at the
institution in which the inmate is housed), with a copy to
the Department's Regional Mental Health Consultant (RMHC).
The e-mail will specify a due date for evaluation and the
date the final report must be sent to the FPC, via regular
mail. After recording the referral on the "FPC Request
Log," the DMHS' office will send an e-mail to the
institutional Senior Psychologist, with copy to the
Department's RMHC, directing that the inmate is to be
interviewed in order to determine his/her need for, and
amenability to, the counseling recommended. This e-mail
will include two due dates: a date by which institutional
mental health staff must determine need and amenability
for counseling (typically three (3) weeks from the date of
the DMHS office's e-mail); and a date by which counseling
(if indicated) must be completed (typically 210 days [7
months] from the date of the e-mail; or 30 days prior to
the month of the next scheduled FPC review, whichever is
sooner).
2) Upon receipt of the request, institutional mental health
(MH) staff will initiate a mental health "hold", and
acknowledge receipt of the request as well as the intent
to complete the evaluation and report by the due date. The
request acknowledgement will be sent via e-mail to the
DMHS, with a copy to the Department's RMHC.
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3) If the inmate is transferred to another facility before a
mental health hold is initiated, institutional MH staff
at the institution from which the inmate transferred
shall forward (e-mail) the request to the new
institution, whose MH staff shall perform actions
specified in paragraph 2, above.
4) If the inmate is transported outside of the Department
before the evaluation is completed, (e.g., to outside
court), institutional MH staff will so advise the DMHS,
whose office will provide monthly status reports until
the inmate returns. If the inmate has not returned by
seven (7) days prior to the due date, institutional MH
staff shall so advise the DMHS, who shall advise the FPC
that the report may be delayed due to the inmate's
unavailability.
5) Institutional MH staff shall review the health record,
interview the inmate, and determine whether the inmate
needs and is amenable (voluntarily consents) to
counseling/therapy. Institutional MH staff shall e-mail a
draft determination, together with sufficient
justification, to the Department's RMHC for review.
6) Institutional MH staff shall complete a draft report
before the due date, allowing sufficient time for review
of the draft by the Department's RMHC. Each RMHC will set
specific parameters in their region regarding the number
of days that must be allowed for regional review and
shall forward the draft report to the RMHC for review.
The RMHC will indicate approval of the draft via e-mail.
7) Upon receiving written notice of approval from the RMHC,
institutional MH staff will mail the final report to the
FPC, and advise (by e-mail) the RMHC and the DMHS that
the report has been mailed. Institutional MH staff will
file a copy of the report, together with the RMHC's
approval e-mail, in the health record.
8) The RMHC shall review all determinations, whether therapy
is recommended or not, and will either concur or disagree
with the determination, communicating this decision via
e-mail as appropriate, with a copy to the institutional
Senior Psychologist.
9) The Senior Psychologist will then ensure that the e-mail
containing the draft determination and the Department's
RMHC's e-mail are filed in the Other Mental Health
Related Correspondence section of the health record.
10) Institutional MH staff will schedule the needed
counseling/therapy to ensure that it is completed by the
due date.
11) When counseling/therapy has been completed or
discontinued for a valid reason (e.g., inmate later found
to be not amenable), institutional MH staff shall send an
e-mail to the RMHC, advising of the following:
beginning/ending date of counseling; total number of
sessions attended versus offered; and whether the
inmate's attendance/participation was satisfactory.
12) The Senior Psychologist shall ensure that the e-mail
summary of counseling provided is filed in the Other
Mental Health Related Correspondence section of the
health record, and shall discontinue the mental health
hold.
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b. Interstate Compact Office Referrals for Psychological
Evaluation:
Interstate Compact Office referrals will generally request a
psychological evaluation on behalf of another state parole
board. Requests for mental health evaluations from the
Interstate Compact Office (ICO) (for institutions) will be
sent via e-mail to the Department's DMHS. The request will
include any specific questions or concerns that the
out-of-state Parole Board wants addressed in the report.
1) The DMHS's office will record the request on the
"Interstate Compact Log", confirm the location of the
inmate, and forward the request (via e-mail) to the Senior
Psychologist (at the institution in which the inmate is
housed), with a copy to the Department's RMHC. The e-mail
will specify a due date for the evaluation and the date by
which the report is to be completed (including
review/approval by the RMHC) and mailed to the Interstate
Compact Administrator for the Office of Institutions.
Generally, the due date will be three (3) weeks from the
date of the requesting e-mail, although a shorter interval
may be specified in rare situations.
2) Upon receipt of the request, MH staff will initiate a
mental health "hold", and acknowledge receipt of the
request as well as the intent to complete the evaluation
and report by the due date. Inmates involved in
psychological diagnostic testing and evaluation must be
placed on a mental health hold to avoid transfer of the
inmate prior to completion of the evaluation. The request
acknowledgement will be sent via e-mail to the DMHS with a
copy to the Department's RMHC.
3) If the inmate is transferred to another facility before a
mental health hold is initiated, institutional MH staff at
the institution from which the inmate transferred shall
forward (e-mail) the request to the new institution, whose
MH staff shall perform actions specified in paragraph 2,
above.
4) If the inmate is transported outside of the Department
before the evaluation is completed, (e.g., to outside
court), institutional MH staff will so advise the DMHS,
whose office will provide monthly status reports until the
inmate returns. If the inmate has not returned by seven
(7) days prior to the due date, institutional MH staff
shall so advise the DMHS, who shall advise the ICO that
the report may be delayed due to inmate's unavailability.
5) Institutional MH staff shall review the health record,
interview the inmate, and determine whether the inmate
needs and is amenable (voluntarily consents) to
counseling/therapy. Institutional MH staff shall e-mail a
draft determination, together with sufficient
justification, to the Department's RMHC for review.
6) Institutional MH staff shall complete a draft report
before the due date, allowing sufficient time for review
of the draft by the Department's RMHC. As with FPC
referrals, the RMHC will set specific parameters in their
region regarding the number of days that must be allowed
for regional review and shall forward the draft report to
the RMHC for review The RMHC will indicate approval of the
draft via e-mail.
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7) Upon receiving written notice of approval from the RMHC,
institutional MH staff will mail the final report to the ICO, and
advise (by e-mail) the RMHC and the DMHS that the report has been
mailed. Institutional MH staff will file a copy of the final report,
together with the RMHC's approval e-mail, in the health record.
24. Other Mental Health Services
a. Marriage Consultations
A request for input from the institutional chaplain regarding an
inmate's upcoming marriage may be referred. Any input should be
strictly limited to the referral question.
b. Inmate Co-Payment Procedure
There is no inmate co-payment required for mental health services that
are mandated by the Department's mental health program, for example:
orientation, assessment, case management, or evaluations.
There shall be no charge to the inmate for valid emergency mental
health intervention. The mental health professional will determine the
legitimacy of the emergency. Inmate-declared emergencies assessed as
not genuine by mental health staff are subject to co-payment by the
inmate. A thorough discussion of emergency declarations, i.e., thoughts
of self-harm, hearing voices, and co-payment requirements should be
described during inmate orientation.
All non-emergency inmate-initiated mental healthcare visits require a
co-payment (per legislation). Mental health staff should check
"co-payment" on the encounter form as services must be provided whether
or not the inmate has available funds.
Co-payments are not required for:
1) An inmate encounter which is prompted by a staff (mental health or
non-mental health) referral (either written or verbal).
2) A visit in conjunction with an extraordinary event that could not be
reasonably foreseen, such as disturbance or a natural disaster.
3) A visit initiated by the mental healthcare provider or for follow-up
visits.
4) Participation in group psychotherapy or any other form of mental
health service in compliance with the inmate's Individualized
Service Plan.
5) Marriage consultation.
6) Additional instances as indicated in TI 15.05.18, TI 15.05.08,
Procedure 401.010 - Co-Payment Requirements for Inmate Medical
Encounter, and HCS 25.05.01 (or appropriate Health Services
document).
c. Neurological Emergencies
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Neurological emergencies, namely epileptic seizures and acute
headaches, are not to be handled by mental health services and will be
referred to the institutional medical staff.
d. Hunger Strikes
Hunger strikes shall first be considered a medical emergency (HSB
15.02.13) for which mental health staff may be consulted. If requested,
the inmates' Senior Psychologist or psychiatrist will evaluate and
render an opinion on the inmate's mental health status.
25. Mental Health Records and Documentation
a. Documentation
The Department utilizes a detailed record-keeping system to document
delivery of services to inmates. Accurate and complete documentation
will be expected of all mental health staff. This includes appropriate
filing of all inmate records. Mental health records consist of the
mental health section of the health record (green cover), the
psychological record jacket (Form DC-761), and a computerized system
which tracks inmate specific information including mental health
services for all inmates statewide, the Offender Based Information
System (OBIS). All mental health personnel shall attend a three-day
course on utilization of OBIS. FAILURE TO MAINTAIN OBIS ACCURATELY AND
PROMPTLY BY NOT MAKING ALL REQUIRED ENTRIES WILL BE CONSIDERED
NON-COMPLIANCE WITH CONTRACT TERMS AND CONDITIONS FOR WHICH BREACH MAY
BE DECLARED OR LIQUIDATED DAMAGES IMPOSED.
b. Record Keeping
For all appropriate mental healthcare provided, psychiatrists,
psychologists, psychological specialists, and nurses shall record all
significant observations pertinent to inmate care and treatment at the
time service is rendered. Chart entries are to reflect the
Individualized Service Plan (ISP). An inmate's mental health record
shall be reviewed each time s/he appears for a mental health encounter.
The mental healthcare provider shall legibly document each entry using
only a black ballpoint pen. The provider stamp shall be used following
each entry. The provider stamp shall include the mental healthcare
provider's name, title, and institutional identification.
c. Service Delivery Logs
Mental health programs in each institution shall maintain a set of
logs. Details of the requirements for each log can be found in HSB
15.05.17. FAILURE TO MAINTAIN LOGS AS REQUIRED WILL BE CONSIDERED
NON-COMPLIANCE WITH CONTRACT TERMS AND CONDITIONS FOR WHICH BREACH MAY
BE DECLARED OR LIQUIDATED DAMAGES IMPOSED.
d. Forms (General Information)
All required forms shall be utilized in delivery of mental health
services at the institutions. Information regarding the types of forms
and their location in the health record can be found in TI 15.12.03.
Thorough and concise documentation is an essential part of the clinical
services provided to all inmates. All mental health providers shall
become familiar with all forms including how to complete and to file
the forms in the health record.
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x. XXXX Encounter Form (Form DC4-700M Mental Health)
Unless the inmate encounter is entered into OBIS by the practitioner
during or immediately following the encounter, OBIS encounter forms
shall be used to document all inmate encounters (and thus serve as a
part of the record of care) and to track daily workload. Required OBIS
entries are mandatory and must be made in a timely fashion.
All information entered into OBIS must correspond with the
documentation recorded in the mental health record. Forms DC4-700M for
Mental Health encounters and DC4-700B (male) and DC4-700C (female) for
Medical encounters shall be used.
When an encounter form is used to document the inmate encounter, the
information must be entered into OBIS within forty eight (48) hours of
the inmate encounter.
OBIS maintains numerous computer generated deficiency reports. The
Contractor shall run such reports at least weekly to identify any
deficiencies in recording of information.
f. Chronological Record of Healthcare (Form DC4-701)
The Chronological Record of Healthcare (Form DC4-701) shall be used for
documentation of outpatient medical care. "Seen in Mental Health" is
usually the only entry documented on Form DC4-701 by mental health
staff.
Each entry must be legible and be dated, timed, signed, and stamped by
the healthcare Provider.
g. Problem List (Form DC4-730)
Every mental healthcare provider has the authority to identify and
enter a mental health problem. The problem list (Form DC4-730) is to be
updated on an ongoing basis as problems are identified. The Contractor
shall comply with TI 15.12.03 in identifying and documenting problems.
Problems that are resolved must be indicated on the problem list with
date, signature, and stamp.
h. Mental Health Progress Notes (Form DC4-642)
Any clinical contact with an inmate will require a progress note which
shall be written in SOAP format on Form DC4-642 Chronological Record of
Outpatient Mental Healthcare (sometimes referred to as mental health
progress notes) and placed in the mental health section of the health
record in reverse chronological order. Relevant clinical information
stemming from other than a clinical encounter with the inmate, such as
from contact with staff or significant others, shall be documented in
an incidental note on Form DC4-642. The incidental note shall not be
written in SOAP format. All progress notes whether incidental or SOAP
must be dated, timed, signed, and stamped and, when indicated,
cross-referenced to a specific problem from the Form XX0-000 Xxxxxxx
List.
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All progress notes concerning outpatient mental healthcare, including
incidental and SOAP notes, shall be made in the mental health section
of the health record on Form DC4-642 Chronological Record of Outpatient
Mental Healthcare. This also includes written medication orders, which
shall be included under the "P" part of the psychiatrist's SOAP note.
All progress notes made in the health record shall be keyed to a
problem which should be listed on the XX0-000 Xxxxxxx List and
identified by one of the three-digit code numbers listed in the Problem
Index in HSB 15.05.11. The problem list is located on the left side of
the health record. Each problem for which an inmate is being treated by
mental health services shall be listed sequentially on the problem
list.
Except for group therapy contacts, each clinical encounter shall be
documented in SOAP format in the mental health section of the health
record on Form DC4-642 Chronological Record of Outpatient Mental
Healthcare as soon as possible, but not later than the date of the
encounter. Group therapy contacts shall be documented with a SOAP note
after the first group session, after the last group session, and on a
monthly basis while the group is in progress. The monthly SOAP note
shall include the ratio of attended versus scheduled sessions, the
inmate's relative participation, and his/her progress toward ISP
objectives. Documentation of relevant information from sources other
than a clinical encounter shall be in the form of an incidental note,
also on the DC4-642.
All SOAP notes shall be written in accordance with TI 15.05.18.
i. Psychological Record (Form DC4-761) (Orange Folder)
Institutional mental health support staff shall open a psychological
record (orange folder) using Form DC4-761 for any inmate for whom such
a record does not already exist. The psychological record shall contain
psychological test forms and protocols only. It shall be maintained in
a secure location in the mental health services area under the direct
responsibility of mental health staff in order to protect the
confidentiality of test items and protocols. Access to the
psychological record shall be given to mental health staff, staff who
are performing official audits, and others on a need-to-know basis as
determined by the Chief Health Officer. SOAP or other progress notes
shall never be made in the psychological record.
The psychological record (together with the health record) shall
accompany the inmate upon transfer to another institution. Mental
health support staff shall retrieve the inmate psychological record and
place it in an envelope, which shall then be sealed and stamped
"Confidential" (which indicates that the envelope contains sensitive
mental health material).
When an inmate reaches their end-of-sentence (EOS), the psychological
record shall accompany the rest of the inmate's Department records to
the Department archives repository at Reception and Medical Center. The
same procedure as for institutional transfer shall be followed: the
envelope should clearly indicate inmate name and number and that the
information contained is confidential.
j. Refusal of Mental Healthcare Services (Form DC4-711 A)
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Refusals of mental health evaluation/treatment shall be documented on
Form DC4-711 A, Refusal of Healthcare Services Affidavit, which should
be filed under the Mental Health Authorizations and Consents
subdivider.
k. Other Documentation Requirements
Staff shall routinely make every reasonable attempt to obtain records
of past evaluations and treatment performed outside the department.
Such attempts should be briefly documented as an incident that shall be
filed under the Other Mental Health Related Correspondence subdivider
and an incidental note must be written on the Form DC4-642 to document
the date that each inmate request was received and answered. A stamp
will suffice for this purpose. The pink copy of the inmate request
should be filed under the Other Mental Health Related Correspondence
subdivider. The case manager has the primary responsibility for
requesting past mental health records.
Discontinuance of outpatient care (e.g., case management,
psychotherapy, pharmacotherapy) because it is no longer clinically
indicated shall be documented on the Form DC4-661 Outpatient Treatment
Summary, which must be prepared within the time frame specified in HSB
15.05.11 and TI 15.05.18.
Group contacts (i.e., for group therapy or counseling) must be recorded
on a roster (e.g., Form DC4-740) maintained by the Contractor. A SOAP
note must indicate the number of sessions the inmate attended as well
as his/her relative progress and participation.
Inmate requests for mental health interviews shall be documented and
filed. A stamped verification shall be placed on the Form DC4-642 by
mental health support staff to document that the inmate request for
interview was received, answered, and an appointment arranged.
Each documented contact in the mental health section made on the Form
DC4-642 shall have a corresponding entry reading "Seen in Mental
Health" on the Form DC4-701 located in the medical section of the
healthcare record.
M. Dental Services
1. General Overview
The Contractor shall be responsible for all inmate dental services. This
includes all care that is normally provided in the dental unit, including
dental oral surgery that can not be performed in the unit, as well as
responding to any emergencies occurring in the dental area until
appropriate medical or mental health providers arrive. The vendor must
have a Florida licensed dentist overseeing the dental program in
accordance with FS 466.0285.
2. Dental Examinations/Assessments
a. Every inmate shall receive an intake dental examination at the
reception center by a dentist. The intake dental examination shall take
place no later than seven (7) days after reception. Each examination of
this type shall include, at a minimum, a visual
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clinical exam of the head, neck, intraoral areas for any pathology and
charting consisting of: missing teeth, restorations present, fixed or
removable prosthetics, gingival conditions, deposits, masticating
efficiency, treatment indicated (provisional treatment plan), dental
grade, and emergency dental needs.
b. Each inmate shall receive an orientation to dental services, which
includes information on available hours of service and how to access
dental care at the institution, within seven (7) days of arrival at the
assigned institution. The DC4-724 Dental Treatment Record shall be
reviewed for emergency/urgent dental needs or follow-up care. If an
inmate's dental record has not been received by the assigned
institution within seven (7) days or the inmate has not had a dental
examination in accordance with TI 15.04.03 Guidelines for Periodic
Dental Oral Examinations, a dental examination is to be completed as
soon as possible at the assigned institution and a replacement dental
record generated where indicated.
c. Each inmate shall receive a periodic dental examination in accordance
with TI 15.04.03. Each periodic examination shall consist of a clinical
examination of the head, neck and intra-oral areas, evaluation of
urgent dental needs, and completion of a Form DC4-735, Dental Clinical
Examination Report.
d. A dental examination/assessment shall be performed by a dentist on
confined individuals, when determined necessary.
e. Before commencing with routine dental treatment, a diagnosis and
treatment plan shall be derived from the following: a clinical
examination, pathology examination, radiographs, study models and
plaque evaluation as appropriate, charting, and health history. Form
DC4-764 Dental Diagnosis and Treatment Plan, Form DC4-767 Periodontal
Charting, and Form DC4-767A Plaque Control Record shall be used in
conjunction with Form DC4-724 Dental Treatment Record.
f. The topical application of fluoride shall be included in the dental
treatment plan as deemed necessary by the treating dentist. The topical
application of fluoride shall, however, be included as part of the
dental treatment plan for all youthful offenders.
3. Priorities for Dental Treatment
a. Emergency Dental Treatment: Emergency dental treatment will be
available on a twenty four (24) hour basis through the on-duty dental
staff during working hours. In the event a dentist is not available at
a facility to treat a dental emergency, the emergency will be referred
to the medical department in accordance with standard dental emergency
protocols and dental emergency policies which must provide back-up
dental coverage. There is to be no waiting list for dental emergencies.
Dental emergencies generally include fractured jaw, excessive bleeding
or hemorrhage, acute abscess, and/or other acute conditions.
b. Urgent Non-emergency Dental Treatment: All Department of Corrections'
dental clinics shall hold daily (five (5) days a week Monday through
Friday) sick call to provide dental access to those inmate patients who
cannot wait for a routine appointment and yet do not meet the criteria
for emergency care.
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Urgent Non-emergency Dental Treatment includes toothaches, chronic
abscesses, fractured teeth, lost fillings, teeth sensitive to hot and
cold, broken and/or ill-fitting dentures, and other chronic conditions.
Dental sick-call hours shall be set in accordance with each Senior
Dentist's preference, and dental sick call shall be held for one (1) to
two (2) hours daily in the early morning. Special arrangements shall be
made to prevent excessive (more than seven (7) days') backlog.
If an inmate is in need of urgent non-emergency dental care and the
necessary dental treatment cannot be completed that day, the inmate is
to be treated palliatively and treatment rescheduled as soon as
possible, but in no event longer than ten (10) working days.
c. Regular or Routine Dental Treatment: This treatment generally includes
Partial and Complete Dentures, Denture Repairs, Dental Radiology,
Endodontics, Fixed Prosthetics, Oral Surgery, Periodontics, Preventive
Dentistry and Restorative Dentistry. (Further examples are contained in
TI 15.04.13 Supplement C.)
Each inmate may submit a written request upon reaching eligibility to
obtain dental care (Form DC6-236 - Inmate Request). When a request is
received, the inmate's name shall be placed on a list of individuals
awaiting services on a first-come, first-served basis. However, those
individuals without sufficient teeth for proper mastication of food, or
those deemed by the dentist to be in urgent need of dental care, are to
have a higher priority in the scheduling of appointments.
Note: The Contractor shall ensure that dentists and/or their staff are
available for treatment of dental emergencies and shall respond to same
within twenty-four (24) hours of occurrence.
The Contractor shall have back-up dental coverage when the
institution's dentists are not available. The list of back-up dentists
must include a location for emergent/life threatening care.
4. Levels of Dental Care
Dental services available to inmates are based upon four (4) levels of
dental care:
a. Level I
This level of dental care shall be provided to inmates during the
reception process. Level I services shall include, but not be limited
to:
1) An intake dental examination performed by a dentist and development
of a provisional treatment plan using Form DC4-735 Dental Clinical
Examination Report;
2) Necessary extractions as determined by the intake dental
examination; and
3) Emergency dental treatment including treatment of soft tissue
pathology.
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b. Level II
This level of dental care shall be provided to inmates with less than
six (6) months of Department of Corrections' incarceration time
remaining to be served. Level II services shall include, but not be
limited to:
1) All Level I care;
2) Caries control (reversible pulpitis) with temporary restorations;
3) Gross cavitron debridement of symptomatic areas with emphasis on
oral hygiene practices;
4) Complete and partial denture repairs provided the inmate has
sufficient Department-incarceration time remaining on his/her
sentence to complete the repair. In cases of medical necessity, a
complete denture(s) shall be fabricated if the inmate has at least
six (6) months of continuous Department-incarceration time remaining
on his/her sentence.
c. Level III
This level of dental care shall be provided to inmates who have served
six (6) months or more of continuous Department of Corrections'
incarceration time. Level III service shall include, but is not limited
to:
1) All Level I and Level II care;
2) Complete dental examination with radiographs, Periodontal Screening
and Recording (PSR) and any development of a dental treatment plan
(DC4-764);
3) Prophylaxis with definitive debridement. Periodontal examination as
indicated by the Periodontal Screening and Recording (PSR), oral
hygiene instructions with emphasis on preventive dentistry;
4) Complete denture(s) provided the inmate has at least six (6) months
of continuous Department-incarceration time remaining on his/her
sentence;
5) After the inmate has received a complete prophylaxis with definitive
debridement, he/she is eligible for restorative, amalgams, resins,
glass ionomers, chairside post and cores.
6) Removable Prosthetics
a) Acrylic partial dentures provided the inmate has at least six (6)
months of continuous Department-incarceration time remaining on
his/her sentence;
b) Relines and rebases (provided the inmate has enough continuous
Department-incarceration time remaining to complete the
procedure);
7) Anterior Endodontics (Canine - Canine), provided the tooth in
question has adequate periodontal support and has a good prognosis
of restorability and long-term retention.
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8) Posterior Endodontics
a) Either at the local facility or by referral to the Reception and
Medical Center.
b) The tooth must be crucial to arch integrity (no missing teeth in
the quadrant or necessary as a partial denture abutment), have
adequate periodontal support, and have a good prognosis of
restorability and long-term retention.
c) The inmate must have at least six (6) months of continuous
Department-incarceration time remaining on his/her sentence.
9) Basic non-surgical therapy, as necessary.
d. Level IV (Advanced Dental Services)
This level of dental care represents advanced dental services to be
provided to inmates on an as-needed basis after completion of Level III
services and successful demonstration of a Plaque Index Score of ninety
percent (90%) or better for two (2) consecutive months. If an inmate
does not achieve the required Plaque Index Score, he/she shall be
rescheduled in three (3) months for another follow-up plaque score. If
the required ninety percent (90%) plaque score is not obtained,
advanced dental services shall not be considered.
Dental care and follow-up to highly specialized procedures such as
orthodontics and implants placed before incarceration shall be managed
on an individual basis after consulting with the Department's Director
of Dental Services.
Dental care and follow-up to oral surgery and pathology-related issues
shall be provided in accordance with appropriate technical
instructions.
5. Dental Hygiene and Preventive Dentistry
The Florida Department of Corrections' Dental Services Program emphasizes
preventive dentistry that strives to restore and maintain the inmate's
dentition to an acceptable level of masticatory function within
appropriate departmental guidelines. Most gingivitis, periodontal disease,
and tooth loss can be prevented and these conditions are caused by local
factors that are accessible, correctable, and controllable. The primary
participants in any preventive dentistry program are the patients
(inmates), who must assist in the process by removal of dental plaque, a
significant cause of oral disease.
a. For any preventive program to work, emphasis must be placed on
maintaining an acceptable level of oral hygiene. The following three
(3) essential oral hygiene aids, as approved by the Department's
Director of Institutions shall be made available to all inmates:
1) An acceptable soft-bristled adult toothbrush;
2) An acceptable toothpaste containing fluoride; and
3) A type of floss.
b. Preventive dentistry shall be taught to all inmate patients. This shall
be accomplished in two (2) ways:
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1) Prevention training with oral hygiene instructions shall be given
to each inmate as part of his/her orientation to the institution.
This training is to include instructions in proper usage of the
three (3) essential oral hygiene aids (toothbrush, toothpaste,
and some type of floss). This training shall be coordinated with
the institutional orientation. (This can be accomplished either
through a direct presentation or videotape.)
2) Personal preventive training with oral hygiene instructions shall
be included as part of an inmate's dental treatment plan. Oral
hygiene instructions shall be reinforced throughout the dental
treatment plan.
In addition, all dental clinics shall obtain Preventive
Dentistry/Oral Hygiene posters and/or plaques for viewing by inmate
patients.
6. Dentures/Prosthetics
NOTE (For All Removable Prosthetics): Each inmate is responsible for the
loss, destruction or mutilation of removable prosthetics. Failure to take
responsibility for the removable prosthetics is not justification for
replacement at Department of Corrections' expense. Upon the inmate's
receipt of a denture(s), Form DC4-724A Receipt of Provisions Received
shall be completed and placed in chronological order on the left-hand side
of the dental record (Form DC4-745A). Senior Dentists are allowed
discretion to provide replacement removable prosthetics when it is
determined that the original prosthetics were inadvertently lost or
damaged. An incident report and/or additional documentation shall be
presented to the dentist before a replacement is fabricated at no charge
to the inmate. In cases where intentional damage or loss is suggested, the
incident shall be considered the same as willfully damaging state property
and shall be dealt with in accordance with existing institutional
policies.
Justification for replacement shall be properly documented on Form DC4-724
Dental Treatment Record.
a. Acrylic Partial Denture(s)
1) Acrylic partial dentures are defined as Level III dental care.
2) Acrylic partial dentures shall not be made for purely cosmetic
purposes. Three (3) or more anterior teeth in an arch must be
missing before an anterior acrylic partial denture is considered.
3) The following criteria apply to the fabrication of routine acrylic
partial dentures:
a) The diagnosis for an acrylic partial denture shall be documented
on Form DC4-764 Dental Diagnosis and Treatment Plan.
b) The acrylic partial denture may be fabricated as part of the
dental treatment plan after six (6) or more months of continuous
Department of Corrections' incarceration time.
c) The inmate shall have at least six (6) months of continuous
Department of Corrections' incarceration time remaining on
his/her sentence.
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d) In the treating dentist's opinion, there are an insufficient
number of teeth (including replacements) to masticate a normal
diet. Seven (7) or less occluding posterior teeth is considered
to be an insufficient number (posterior teeth are defined as
premolars and molars).
e) This may be modified at the discretion of the treating dentist
based upon clinical need.
f) All Level I, II, and III dental care shall be completed including
extractions, restorative, endodontic procedures, and prophylaxis
before the fabrication of an acrylic partial denture(s).
g) One acrylic partial denture(s) shall be provided in a lifetime
with one reline provided at no cost to the inmate. Acrylic
partial denture(s) required more often shall be charged to the
inmate unless such a requirement is caused by a change in the
inmate's dental condition that renders the existing acrylic
partial denture(s) nonfunctional.
b. Cast Partial Dentures
1) Cast partial dentures shall be fabricated only when the oral
condition precludes the fabrication of an acrylic partial denture.
2) The following criteria apply to the fabrication of cast partial
dentures:
a) The diagnosis for a cast partial denture(s) must be documented on
Form DC4-764 Dental Diagnosis and Treatment Plan.
b) The cast partial denture may be fabricated as part of the dental
treatment plan after six (6) months of continuous Department of
Corrections' incarceration time.
c) The inmate must have at least six (6) months of continuous
Department of Corrections' incarceration time remaining on
his/her sentence.
d) In the treating dentist's opinion, there is an insufficient
number of teeth (including replacements) to masticate a normal
diet. Seven (7) or less occluding posterior teeth is considered
to be an insufficient number (posterior teeth are defined as
premolars and molars). This may be modified at the discretion of
the treating dentist based upon clinical need.
e) All Level I, II, and III dental care must be completed including
extractions, restorative, endodontic procedures, and prophylaxis
before the fabrication of cast partial dentures.
f) When indicated, a cast partial denture(s) shall be provided only
once in a lifetime with one reline provided at no cost to the
inmate. When indicated, cast partial denture(s) required more
often shall be charged to the inmate unless such a requirement is
caused by a change in the inmate's dental condition that renders
the existing cast partial denture(s) nonfunctional.
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c. Complete Denture(s)
1) Complete dentures are defined as Level III dental care unless
necessitated by a medical condition which is Level II care. All
complete dentures must be diagnosed on the Form DC4-764 Dental
Diagnosis and Treatment Plan.
2) For inmates entering the Department of Corrections who are
edentulous in one or both arches, the reception center dentist shall
enter a comment on the intake screening examination defining the
length of time the inmate has been without dentures. This shall aid
in determining an inmate's masticating ability without dentures. It
does not indicate there is an immediate need for Level II prosthetic
treatment.
3) Level II (Complete Dentures)
a) Complete dentures shall only be fabricated due to a diagnosed
medical condition and only at the request of a physician.
b) This request shall be thoroughly documented on the Form DC4-724
Dental Treatment Record.
c) The inmate must have at least six (6) months of continuous
Department of Corrections' incarceration time remaining on
his/her sentence.
4) Level III (Complete Dentures)
a) Complete dentures may be fabricated as part of the dental
treatment plan after six (6) months of continuous Department of
Corrections' incarceration time.
b) The inmate must have at least six (6) months of continuous
Department of Corrections' incarceration time remaining on
his/her sentence.
c) Immediate dentures shall not be fabricated.
d) One complete denture(s) shall be provided in a lifetime with one
reline provided at no cost to the inmate. Complete dentures
required more often will be charged to the inmate unless such a
requirement is caused by a change in the inmate's alveolar
condition where a rebase or reline is contraindicated.
7. Complete or Partial Denture Repairs
a. All inmates, regardless of incarceration time, are eligible for
complete and/or partial denture repairs provided such repairs can be
completed before the inmate is released from the custody of the
Department of Corrections.
b. All complete and/or partial denture repairs shall be assessed a
co-payment fee unless the prosthesis is defective.
c. All repairs requiring dental laboratory services shall be sent to the
PRIDE Dental Laboratory, located at Union Correctional Institution,
utilizing Form DC4-720
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Laboratory Procedure Authorization. The one exception is that all
partials and dentures with gold and/or gold shell crowns shall be sent
to an outside dental lab (not to the PRIDE Dental Laboratory). Because
of the involvement of an outside dental lab, the inmate's bank account
shall be charged the entire lab xxxx for these repairs.
NOTE: No denture repairs are to be done for inmates in the reception
process or transient status.
8. Dental Radiology
a. Dental radiographs shall be exposed in accordance with TI 15.04.06. A
minimum of six (6) periapical and two (2) bitewing radiographs are
required to develop a dental treatment plan. A treatment plan series of
radiographs and/or panorex are acceptable for a five-year period of
time. Bitewing radiographs are acceptable for a two-year period of
time. Dental radiographs are to be mounted dot out.
b. Appropriate dental radiology operating and safety procedures shall be
utilized, including but not limited to:
1) Use of a lead apron for all intraoral radiographs.
2) Inspection of the dental x-ray machine by the Department of Health
(DOH). This is usually done at five-(5) year intervals.
3) Use of a rectangular lead-lined collimator for most intraoral
radiographs.
4) Periapical radiographs exposed during oral surgery and endodontic
therapy or occlusal and/or extraoral radiographs necessitate the
usage of a round lead-lined collimator.
5) All x-ray machine operators must be certified or undergoing
radiology training in accordance with Department of Health (DOH)
guidelines.
6) All x-ray machines must be registered through the Department of
Health (DOH) and a registration certificate must be posted near the
dental x-ray machine.
c. All dental radiographs are to be placed in the pocket on the right-hand
side of the dental record (DC4-745A).
d. Radiographs exposed for endodontic therapy (minimum of pre- and
post-treatment) shall be mounted in sequence using the same mount.
9. Endodontics
a. Endodontic/Root Canal Therapy is available to Level I and II inmates
(less than six months of continuous Department of Corrections'
incarceration time remaining) on an emergency basis only (i.e.,
emergency pulpotomies, pulpectomies).
b. Nonemergency endodontic therapy is available to Level III inmates
(those with six (6) or more months of continuous Department of
Corrections' incarceration time remaining) at the discretion of the
treating dentist. All teeth receiving endodontic
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therapy must have adequate periodontal support and have a good
prognosis of restorability and long-term retention. In addition,
posterior teeth receiving endodontic therapy must be crucial to arch
integrity (no missing teeth in the quadrant or necessary as a partial
denture abutment) and the inmate shall have at least six (6) or more
months of verifiable continuous Department of Corrections'
incarceration time remaining on his/her sentence.
c. All routine endodontic therapy shall be completed at the local
institution. Should a difficult/abnormal case be encountered or
complications develop which cannot be treated at the local institution,
referral to an endodontist must be available.
10. Fixed Prosthetics (Crown and Bridge)
a. Fixed prosthetics (crowns) are defined as Level IV (advanced) dental
care.
b. To receive either a crown or a bridge, the inmate must have at least
six (6) months of verifiable continuous incarceration time remaining on
his/her sentence.
c. Crowns are not to be done except for unusual circumstances and only
when an adequate restoration cannot be placed.
d. A crown may be fabricated due to traumatic injury to the tooth
occurring while performing institutional work if supported by a
verifiable incident report.
e. A crown may be fabricated due to traumatic injury to the tooth
occurring due to use of force if supported by a verifiable incident
report.
f. Replacement of current pre-incarceration single-unit crowns due to
recurrent decay, etc. The lab xxxx shall be charged to the inmate's
bank account.
g. Fixed bridges are not to be fabricated.
h. All teeth involved in fixed prosthetic (crowns) therapy must have
adequate periodontal support and no mobility, other than physiologic.
All teeth must have a good prognosis of restorability and long-term
retention.
i. The use of gold alternatives is required unless the inmate demonstrates
sensitivity to the metals commonly used for bridge frameworks.
j. Gold shell crowns shall not be fabricated or received from outside
sources. Existing gold shell crowns shall not be re-cemented.
11. Implants
a. The Contractor shall not initiate the placement of implants on any
inmate. However, should an inmate be incarcerated with implants that
have not been completed, the Department will attempt to arrange
continuation of such care at the inmate's expense.
b. Those inmates incarcerated while undergoing implant dentistry shall be
identified by reception center dentists. The name and address of the
treating dentist shall be
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obtained. The inmate's classification officer shall then be contacted
so the inmate can be transferred to an appropriate facility near
his/her treating dentist.
c. The Department will arrange necessary follow-up appointments with the
private dentist and provide transportation to and from the private
dentist's office. However, all expenses incurred at the private
dentist's office and transportation costs shall be the responsibility
of the inmate patient or his/her family.
d. Any inmate whose private (implant) dentist is not located in Florida or
who lacks the availability of funds to follow-up on failing implants
will be handled on a case-by-case basis.
NOTE: The Department of Corrections shall not require the Contractor to
restore dental implants.
12. Oral Surgery
a. A full range of oral surgery is available to all inmates regardless of
incarceration time. Oral surgery for purely cosmetic reasons shall not,
however, be performed.
b. Oral surgery procedures that cannot be accomplished at the institution
must be available by referral to an Oral Surgeon. (Reference: HSBs/TIs
15.01.04 and 15.04.01.)
c. The Contractor shall document justification for removal of asymptomatic
third molars in the dental chart.
13. Orthodontics
a. The Contractor shall only provide orthodontic care to prevent adverse
health impact on an inmate.
b. Those inmates incarcerated while in active orthodontic therapy should
be identified by reception center dentists. The name and address of the
treating orthodontist should be obtained. The inmate's classification
officer should then be contacted so the inmate can be transferred to an
appropriate facility near his/her orthodontist.
c. The Contractor shall arrange necessary follow-up orthodontic
appointments and provide transportation to and from the orthodontist's
office. However, all expenses incurred for orthodontic care and
transportation costs are the responsibility of the inmate patient or
his/her family.
d. Any inmate whose orthodontist is not located in Florida or who lacks
funds for continuation of orthodontic care and who will be incarcerated
for a minimum of one (1) year, should have the bands removed due to the
difficulty in maintaining adequate oral hygiene.
e. Deviations from this standard shall be handled on a case-by-case basis
based upon clinical need and shall be appropriately documented.
14. Periodontics
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a. At all levels of available dental care, the need for adequate home
care/preventive dentistry must be reinforced through oral hygiene
instructions.
b. Group oral hygiene instructions are to be part of inmate orientation at
each institution with one-on-one oral hygiene instructions to be given
at the gross debridement and definitive debridement, prophylaxis
appointment. Adequate self-care should be stressed at subsequent
appointments.
c. A Periodontal Screening and Recording (PSR) is to be included as part
of all Level III comprehensive dental examinations and is to be done at
the treatment planning appointment. The PSR Shall be conducted in
compliance with subsection 16, below. The results of the PSR are to be
recorded on Form DC4-764 Dental Diagnosis and Treatment Plan with an
entry noting the PSR placed on Form DC4-724 Dental Treatment Record.
Sextant charting on Form DC4-767 Periodontal Charting is indicated by
the reading of four (4) on the PSR.
d. Contractor's staff shall instruct inmate patients on daily oral hygiene
practices and shall stress to the inmate patient that the first step of
any definitive dental treatment is the practice of adequate daily oral
hygiene.
x. Xxxxx Debridement -- use cavitron or hand sealers. Definitive
Debridement/Prophylaxis -- fine scale and polish (complete
prophylaxis). A complete prophylaxis is not available until an inmate
has been incarcerated at least six (6) months, unless it is the
professional opinion of the treating dentist that a complete
prophylaxis is required sooner. Subsequent prophylaxes are to be
available no more than once per year, unless the treating dentist
determines a complete prophylaxis is needed sooner. The complete
prophylaxis is to be performed at the beginning of the dental treatment
plan unless emergent or other urgent needs must take priority.
f. The Department advocates the use of nonsurgical periodontal therapy for
cases where pocketing exceeds three (3) millimeters.
15. Restorative Dentistry
a. Routine restorative dentistry is defined as a Level III procedure.
b. Appropriate current radiographs shall be made available and present
before initiating restorative procedures. (Reference TI 15.04.06
Guidelines for Prescribing Dental Radiographs.)
c. Amalgam is the material of choice for Class I and II restorations of
posterior teeth.
d. Amalgam, light-cured resin, and glass ionomer are the materials of
choice for buccal pit and Class V restorations of posterior teeth.
e. Light-cured resin shall be used for anterior restorations. In some
instances, glass ionomer may be utilized. The placement of veneers or
the closure of diastemas for purely cosmetic reasons shall not be done.
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16. PSR Screening System
a. The American Dental Association and the American Academy of
Periodontology recommend the use of this screening system by dentists
to meet the public's need for early diagnosis of periodontal disease in
a convenient and cost-effective manner. Requirements for follow-up
periodontal charting have been modified for use by Florida dentists
providing services in Department facilities.
b. The objective of this screening system is to examine every tooth
individually. Implants are examined in the same manner as naturally
occurring teeth.
c. For screening, the dentition is divided into sextants as shown:
1) The use of a periodontal probe is mandatory.
2) The recommended probe has a ball end 0.5mm in diameter.
3) A color coded area extends from 3.5 to 5.5mm.
4) A gentle probing force should be used.
d. The probe tip is gently inserted into the gingival crevice until
resistance is met. The depth of insertion is read against the color
coding. The total extent of the crevice should be explored by walking
the probe around the crevice. At least six (6) areas in each tooth
should be examined: mesiofacial, midfacial, distofacial, and the
corresponding lingual/palatal areas.
e. For each sextant with one (1) or more teeth or implants, only the
highest score is recorded. An X is recorded if the sextant is
edentulous. A simple box chart is used to record the scores for each
sextant This is noted on the dental treatment plan Form DC4-764.
CODE 0 Colored area of probe remains completely visible in the deepest
crevice in the sextant. No calculus or defective margins are
detected. Gingival tissues are healthy with no bleeding after
gentle probing.
CODE 1 Colored area of probe remains completely visible in the deepest
probing depth in the sextant. No calculus or margins are
detected. There is bleeding after gentle probing.
CODE 2 Colored area of probe remains completely visible in the deepest
probing depth in the sextant. Supra- or subgingival calculus
and/or defective margins are detected.
CODE 3 Colored area of probe remains partly visible in the deepest
probing depth in the sextant.
CODE 4 Colored area of probe completely disappears, indicating probing
depth of greater than 5.5mm.
17. Periodontal Screening and Recording (PSR)
The PRS shall be conducted as a Level III procedure.
a. The examiner may pass to the next sextant whenever code 4 is recorded
or the sextant is completely examined.
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b. In addition to these scores, the asterisk symbol (*) shall be added to
the sextant score whenever individual findings indicate clinical
abnormalities.
CODE*: Denotes clinical abnormalities including but not limited to:
1) Furcation invasion
2) Mobility
3) Mucogingival problems
4) Recession extending to the colored area of the probe (3.5mm
or greater)
c. The management of patients according to their sextant scores will be at
the discretion of the examining dentist. The practitioner's clinical
judgment will determine the need for consultation with a periodontist.
The following guidelines for patient management are suggested:
CODE 0: Appropriate preventive care.
CODE 1: Oral Hygiene Instruction (OHI) and appropriate therapy,
including sub-gingival plaque removal.
CODE 2: OHI and appropriate therapy, including subgingival plaque
removal, plus removal of calculus and correction of
plaque-retentive margins of restorations.
Patients whose scores for all sextants are codes 0, 1, and 2 should be
screened in conjunction with every oral examination.
CODE 3: OHI and appropriate therapy, including subgingival plaque
removal, plus removal of calculus, correction of
plaque-retentive margins of restorations, and root planning as
indicated.
CODE 4: A comprehensive periodontal examination with charting of the
affected sextant is to be included as part of the dental
treatment plan. This examination should include, but not be
limited to, identification and documentation of probing depths,
mobility, gingival recession, mucogingival problems, and
furcation invasions as well as appropriate radiographs. OHI
and appropriate therapy, including subgingival plaque removal,
plus removal of calculus, correction of plaque-retentive
margins of restorations, root planing as indicated, extraction,
or other therapy as deemed appropriate by the treating dentist.
The periodontal charting should be completed prior to
initiation of nonurgent/emergent dental care.
18. Dental Laboratory Services
a. Routine removable prosthetic appliances are required to be fabricated
by the PRIDE Dental Laboratory located at Union Correctional
Institution. In addition, the PRIDE Dental laboratory shall perform
denture repairs, relines, rebases and other miscellaneous procedures on
removable prosthetic appliances. PRIDE'S address is: PRIDE Dental
Laboratory
Union Correctional Institution
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0000 Xxxxxxxxx 000xx Xxxxxx
Xxxxxxx, Xxxxxxx 00000
The one exception is that all partials and dentures with gold and/or
gold shell crowns shall be sent to an outside dental lab (not to the
PRIDE Dental Laboratory).
b. The Contractor shall call the PRIDE Dental Laboratory Supervisor if
there is a question as to whether or not the laboratory can perform the
required procedure.
c. The Contractor shall be responsible for all costs related to shipping
items to and from PRIDE'S laboratory. All dental prosthetic cases must
be disinfected prior to shipping and marked "Sensitive Item".
d. PRIDE Dental Laboratory may also provide limited fixed prosthetic
services although the Contractor shall not be required to use PRIDE for
this. A private dental laboratory may be used for fixed or specialized
prosthetic cases.
N. Pharmacy Services (General Overview)
1. General Overview
The Contractor shall provide and be financially responsible for all
pharmacy services, including the provision of Pharmaceuticals, as
specified in this Contract. All Pharmacy services shall be in accordance
with all applicable federal and state laws, rules and regulations,
Department of Corrections' rules and procedures, and Health Services'
Bulletins/Technical Instructions applicable to the delivery of pharmacy
services in a correctional setting. Applicable Florida laws and
administrative rules include, but are not limited to, Xxxxxxxx 000, 000,
000, xxx 000, Xxxxxxx Xxxxxxxx and Rules 64B16-26, 64B16-27, 64B16-28,
64B16-30, 64F-12, and 64F-13, Florida Administrative Code. Should any of
the above laws, standards, rules or regulations, Department procedures,
HSB/TP's or directives change during the course of this procurement or
resultant Contract term, all updated versions will take precedence.
In addition, the Contractor shall abide by newly amended Sections 499.003,
499.012 and 499.0121 Florida Statutes, as amended, and any administrative
rules adopted pursuant to these statutory sections. In addition, the
Contractor shall meet all state and federal constitutional requirements,
court orders, and any applicable ACA Standards for pharmacy services
(whether mandatory or non-mandatory). All such laws, rules and
regulations, current and/or as revised, are incorporated herein by
reference and made a part of this Contract. The Contractor and the
Department shall work cooperatively to ensure service delivery is in
complete compliance with all such requirements.
2. Permits, Licenses, and Insurance Documentation
a. The Contractor shall maintain, at each institution, current copies of
all required pharmacy-related state and federal licenses, permits, and
registrations. Such documentation shall include, but not be limited to,
current copies of the following:
1) Florida Department of Health Board of Pharmacy Permit (for the
pharmacy);
2) Florida Department of Health Type "B" Modified Class II
Institutional Pharmacy Permit for each institution receiving
services;
Page 50 of 000
XXXXXXXX X0000
0) Xxxxxx Xxxxxx Department of Justice Drug Enforcement Administration
registration for the Pharmacy and for each institution where stock
controlled substances will be stored; and
4) Appropriate Wholesale distribution permit as described in Section
499.012, Florida Statutes.
Copies of the above documentation shall be provided to the Contract
Manager and the Department's Director of Pharmacy Services not later
than January 1, 2006. Any additions/deletions/revisions/renewals to the
above documents made during the Contract period shall be submitted to
the Contract Manager and Department's Director of Pharmacy Services,
within fifteen (15) days of said addition/deletion/revision/renewal. In
addition, copies of the documentation above shall be available for
review at the institution.
b. The Contractor shall also maintain the following documentation at the
institutional site and provide copies and updates, as they occur, to
the Department's Director of Pharmacy Services.
1) the names and the current license numbers of all Registered
Pharmacists working in the pharmacy; and
2) the name and current license number of the Pharmacy Manager as
designated to the Florida Board of Pharmacy.
3. Pharmacy Service Tasks:
a. The Contractor shall provide coverage on-site or on call by a licensed
pharmacist twenty-four (24) hours/day, seven (7) days/week for
emergency needs.
b. All pharmacists providing services under this Contract shall be
provided a beeper or other form of communication mutually agreed upon
by the parties. Each month, the Contractor shall provide to the
Contract Manager and the Director of Pharmacy Services (FDC), the
on-call pharmacists list with applicable phone and/or beeper numbers.
The on-call pharmacists list will be posted at each institution in the
medication room and the infirmary, and will be provided to the Nursing
Director, the Chief Health Officer, and the Contractor's Institutional
Administrator.
c. The Contractor shall provide pharmaceuticals and drugs to the
institution utilizing a "unit dose" method of packaging. Unit doses of
medication to be administered by nursing staff are to be provided in a
patient specific format. If each dose is individually labeled and
packaged, the label shall include the drug name, strength, lot number,
expiration date, and manufacturer. If a modified unit dose system such
as a card or blister pack is utilized, each card or pack shall be
labeled as a prescription. Prescriptions shall minimally be labeled to
include the inmate name and number, drug name, dosage, directions
(frequency of administration), prescribing physician, pharmacist's
initials, date, quantity of tablets, manufacturer, lot number,
expiration date, remaining refills, next refill date, date the
prescription expires (commonly called "discard after date"), and any
applicable warnings or dietary instructions. Medications provided by a
registered re-packager (whether the Contractor or subcontractor) in a
modified unit dose system such as a card or blister pack may be used as
"stock" medications.
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d. Upon request of the Department, the Contractor shall provide liquid
psychotropic medications in unit doses, individually labeled, with
manufacturer, lot number, expiration date and date packaged listed upon
request.
e. The Contractor shall comply with the Department's formulary in all
cases unless a Drug Exception Request (DER) is approved by the Director
for Health Services - Clinical or their designee.
f. The Contractor shall provide other medications in liquid unit doses
properly labeled as specified by the Chief Health Officer.
g. The Contractor shall provide hypodermic supplies to include needles and
syringes and disposal containers that are tamper proof and puncture
resistant. The Contractor shall be responsible for appropriate disposal
and/or destruction of needles and syringes with documentation.
h. The Contractor shall provide on-site stat dose capability for emergency
stock of drugs in unit dose packages to be used in emergency situations
or until regular delivery of medications. The specific drugs shall be
determined by the Department's Pharmacy Services Committee and the
quantities shall be determined by the Chief Health Officer at each
site.
i. The Contractor shall provide emergency drugs as requested by the Chief
Health Officer and approved by the Department's Pharmacy Services
Committee.
j. The Contractor shall properly package all medications in light and/or
humidity resistant containers as appropriate.
k. The Contractor shall package non-controlled, non-abusable medications
in not more than a month's supply as allowed by TI 15.14.02. If the
quantity is larger than 120 tablets, then the supply shall be dispensed
not to exceed one hundred twenty (120) tablets with appropriate
refills.
l. The Contractor shall maintain copies of all prescriptions issued to and
or filled for to inmates in a permanent file for a period of five (5)
years. Copies will be provided to the institution upon request.
m. The Contractor shall maintain appropriate documentation, including but
not limited to, inventory records, controlled drug perpetual inventory,
patient profiles, and cost data for financial records. All
documentation shall be made available for review by the Warden or
designee and the Department's Office of Health Services' Director of
Pharmacy Services.
n. The Contractor shall provide, within one working day, copies of any
pharmacy or medication-related records requested by the Department's
Contractor Manager or Director of Pharmacy Services.
o. The Contractor shall document and maintain a Medication Administration
Record (MAR) to include all information contained on the prescription
label, the name of the practitioner who prescribed the medication, and
any patient allergies.
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p. The Contractor shall provide monthly, to each facility, by the first
(1st) day of each month, a copy of the MAR, utilizing the Department's
format for such, for each inmate receiving direct observed therapy at
the institution
q. In addition to the training requirements in Section 3.25.8, the
Contractor shall perform in-service training for staff on
pharmacy-related material according to a schedule mutually agreed upon
and approved by the Chief Health Officer but presented no less than
twice a year. Such training shall be conducted by a licensed pharmacist
and shall include proper MAR documentation, medication administration
to include when medications are to be issued, medication
incompatibilities and interactions, and documentation on using stock
medications,
r. The Contractor shall provide a licensed pharmacist to perform third
party drug utilization reviews as requested by the Quality Management
Committee.
s. The Contractor shall provide a licensed consultant pharmacist to
conduct monthly inspections of all institution areas where medications
are maintained. Inspection shall include, but not be limited to,
expiration dates, storage and a periodic review of medication records.
The consultant pharmacist's monthly inspection report shall be
completed. One copy shall remain in the pharmacy and a second copy
shall be sent to the Department's Director of Pharmacy Services.
t. The Contractor shall provide a Pharmacist to serve as chairperson of
the Correctional Institution Pharmacy and Therapeutics Committee and to
consult on-site and by telephone with the Chief Health Officer and
staff as requested.
u. The Contractor may choose to participate in an Office of Health
Services' cluster to receive pharmaceuticals and negotiate
administrative costs during the Contract period.
v. The Contractor shall meet all of the following time frames in filling
all prescriptions and other orders, excluding holidays and weekends.
Time frames are defined as the period of time from day-of-order to
day-of receipt by the Department's facilities.
1) Formulary prescriptions shall be filled and received by the facility
no later than the next working day.
2) Non-formulary (after the non-formulary request is approved) or
special order medications shall be filled and shall be received by
the facility by the second working day.
3) Stock medication orders shall be received by the facility by the
next working day.
All orders for any service area/entity received/sent after 1:00 PM
shall be considered received on the following day.
w. The Contractor shall be responsible for all costs for delivery and
return of medication.
x. The Contractor medication supply process shall have "flag indicator
capability" to identify non-formulary medications, flag inmates on more
than three (3) psycho-active medications, flag medications being
prescribed for a condition other than for
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what the medication is indicated, and flag controlled substance
medications being used for more than seven (7) days.
y. The Contractor shall maintain in the pharmacy computer system all
known patient (inmate) allergies.
z. The Contractor shall maintain, at a minimum, an updated drug-drug,
food-drug, food-food, and drug-allergy interaction program in the
pharmacy computer system. The Contractor will produce upon demand, the
latest version being used at the respective institution. Such version
shall be no more than six (6) months old and shall be verifiable by
written notarized statement from the pharmacy's software vendor, if
requested.
aa. Each medication delivery sheet shall contain the inmates name, ID
number, name of medication, strength of medication, and quantity sent.
Each delivery sheet (invoice) shall contain the receiving
institution's name, address, and DEA number; the sending service
area/entity's name address, and DEA number; the name of the medication
sent and quantity of the medication sent.
bb. All stock medications sent to the institution will be invoiced,
separately, as above and will contain the name of the medication and
quantity of the medication being sent. Controlled substances will be
sent on separate invoices.
cc. The Contractor shall provide a signature strip for each Keep-On-Person
(KOP) prescription an inmate receives. These signature strips will be
placed, after being signed, on signature logs. These signature logs
must be kept for two (2) years.
dd. The Contractor shall place, at a minimum, the following information on
each prescription label:
1) Inmate name and DC number,
2) Date the prescription is filled;
3) Pharmacy name and address;
4) Prescription number;
5) Name of medication, strength, and amount dispensed;
6) Directions for use, particularly addressing if tablets are halved;
7) Name of prescribing practitioner;
8) Name or initials of the pharmacist dispensing the prescription;
9) Discard-after-date. This is the date after which the prescription
is no longer valid. To be determined by the practitioner writing on
the prescription order the number of days the order is valid;
10) Next refill date;
11) Cautionary or accessory labels, as required; and
12) If the order is to be issued by Direct Observed Therapy then DOT
is to be placed on the label.
ee. As a cost avoidance issue, the Contractor shall break in half and
appropriately label any medications as requested by the Department. No
medications shall be provided in half-tablets unless approved in
advance, in writing, by the Department's Contract Manager.
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ff. The Contractor will provide to each facility a stock medication order
sheet to include those medications that can be ordered and
"order-up-to" limits. The Contractor shall monitor the ordering of
stock medication at each facility to prevent over-ordering. The
Contractor will have a system developed/in place by Contract execution
date to ensure that stock medication supplies do not exceed fourteen
(14) days.
gg. The Contractor shall supply all current and future medications to be
issued by the Department's practitioners in compliance with
practitioner-dispensing provisions of the Florida Statutes.
hh. Practitioner dispensed medications shall have all required re-packed
medication information plus a label with direction information and
cautionary statements and a separate label so the practitioner can
write the inmates name, DC number, and prescription number on the
package.
ii. Rebate/Credit/Discount Reporting: Any discounts/credits/rebates
received by the Contractor as a result of pharmaceutical orders placed
or processed on behalf of the Department's inmates in Region IV will
be reported to the Contract Manager on a quarterly basis listing each
pharmaceutical company and the corresponding total discount/rebate or
the medication and the corresponding credit issued. If pharmacy
services are subcontracted, the subcontracted pharmacy must provide to
the Contract Manager and the Department's Director of Pharmacy
services, all rebate/credit/discount information. Discounts/rebates
received by the Contractor or subcontracted pharmacy for timely
invoice payment to pharmaceutical companies are not included in this
reporting requirement as they are operational business decisions
related to inventory management.
jj. The Contractor or subcontracted pharmacy shall provide necessary forms
for the credit return process to include when the item was ordered.
kk. The Contractor shall provide, in proper containers, EOS
(End-of-Sentence) medications, INS (Immigration and Naturalization
Services) medications, Outside Court medications, and Work Release
Center medications, in quantities as described in TI 15.14.02.
ll. The Contractor shall have a sufficient number of facsimile machines
and phones lines so as to be able to receive prescription orders,
medication refill requests, stock medication requests, and packaging
requests timely.
mm. The Contractor shall provide to each facility, at Contractor's cost, a
facsimile machine or machines for the purposes of faxing orders and
stock requests.
nn. The Contractor shall have a system in place to minimize medication
shipment errors and to promptly address and correct any shipment
errors.
oo. The Contractor shall have in place, and be able to demonstrate, a
Continuous Quality Improvement program. This program will include
outcome reports from the subcontracted pharmacy on any medication
errors that were the pharmacy's responsibility.
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pp. The Contractor shall participate in statewide and institutional
Pharmacy Services Meetings.
qq. The Contractor shall provide to each inmate, medication education
materials for each medication order. The education materials will, at
a minimum, describe major side effects associated with the medication.
The education materials must be pre-approved by the Department.
rr. The Contractor shall provide IV medications in a manner compatible
with the Department's IV pumps. Select IV medication will be kept
on-site as stock medication. All IV orders are to be profiled in the
Contractor's medication supply process. The Contractor will provide
all IV solutions and tubing.
ss. The Contractor shall contract with a subcontractor(s) to provide
emergency IV medications upon request. The subcontractor will xxxx the
Contractor who shall be responsible for all costs incurred by the
subcontractor when meeting requirements of the Contract. The
Contractor shall ensure that all IV medications are prepared using
aseptic technique.
tt. The Contractor shall keep an updated copy of the Department's
Formulary at each institution.
uu. The Contractor shall provide Over-the-Counter (OTC) medication as
required on both prescription orders and as stock. The OTC medications
provided as stock shall be labeled with appropriate directions for
use, warnings, cautionary statements, lot numbers, and expiration
dates. The Contractor shall provide to each facility OTC medications
approved to be issued to inmates in a dorm setting utilizing the
current packaging system as described in Department of Corrections'
Procedure 406.001.
vv. The Contractor shall issue all formulary controlled substance
medications as bulk stock either as repackaged medication or in the
manufacturer's original unit dosed packaging.
ww. All non-formulary controlled substance medications shall be issued
patient (inmate) specific.
xx. The Contractor shall provide stock medication to include both legend
medications and OTC medications from a list of medications approved by
the Department's Pharmacy Services Committee. The Contractor shall not
add to the list of approved medications without written consent from
the Contract Manager.
yy. All Drug Exception Requests for non-formulary medications, drug dose
variances, four or more psychotropics, nonapproved use of approved
medications, and more than one medication in a mental health treatment
category shall be approved by the Director of Health Services -
Clinical or his/her designee.
4. Pharmacy Policy and Procedure Manuals
Within thirty (30) days of Contract execution, the Contractor shall
provide a policy and procedure manual, to all participating Department
institutions/facilities, the Contract Manager, and the Department's
Director of Pharmacy Services that shall include, but not be limited to,
the following:
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a. Ordering procedures;
b. Process to be used to deliver medications from the time order is
received, including the identification of the courier involved;
c. Return-of-goods procedures, including who to call and how medication is
to be returned, forms to be used, and final disposition of the
medication;
d. How non-formulary items are to be issued including the faxing and
receiving of Drug Exception Requests;
e. Description of the process to be used to resolve problems and issues
between the Contractor and facility or Department, including the name
of a contact person, address, phone, beeper, and facsimile number;
f. How to receive medications;
g. How to distribute medications including Keep-On-Person (KOP), direct
observed therapy, and stock medications;
h. Controlled Substance policy to include ordering, distribution, and
destruction;
i. Psychotropic medication policy to include ordering, distribution, and
return;
j. Use of and name of emergency contracted pharmacy for each facility;
k. Quality related events;
l. Notification of and how to reach the on-call pharmacist;
m. How a medications "pedigree" will be provided to the Department.
n. Duties, responsibilities, and general scope of services for Consultant
Pharmacist and changers to scope of services.
o. How to file, where to file, and length of time all required paperwork
shall be kept including invoices;
p Disposal and/or destruction of medication to include vendor to be used
if medication cannot be disposed of on-site, who can and cannot dispose
of medication, documentation required, and regulatory requirements;
q. Ordering, receiving, and monitoring of legend and OTC stock
medications;
r. Drug Exception Request approval/denial process; and
s. Process to verify orders are received in appropriate time frames.
The Contractor shall update all policy and procedure manuals expeditiously
as changes occur. Copies of changed procedures or other updates shall be
provided to all facilities and the Contract Manager within seven (7)
working days of any change, along with a cover sheet indicating the
current date of the manual. Annually, in January of each calendar year,
the Contractor shall provide new manuals to each Department's facility
served and to the Contract Manager.
5. Pharmacy Audits and Investigations
The Contractor shall provide copies of any pharmacy audit or investigative
report for any reportable condition, performed by any state, federal or
other regulatory agency including reports of no findings, on any permit,
registration, or license, to the Contract Manager within seven (7) working
days of the Contractor receiving the report.
NOTE: THE FOLLOWING SECTIONS APPLY TO CONTRACTOR'S OVERALL HEALTHCARE SERVICE
DELIVERY.
O. Emergencies
1. As required by law, emergencies shall be taken to the nearest hospital
approved by the Department. The Contractor shall ensure the availability
of emergency treatment through predetermined arrangements with local
hospitals. If an inmate should need to be transferred by air, the
Contractor shall use appropriate aviation assets. All ambulances
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utilized shall be equipped with life support systems and shall be operated
by personnel trained in life support that are certified by the State of
Florida. The Contractor shall obtain documentation of State certification
and keep it on file at the institution. The Contractor shall be
responsible for the costs of all emergency air ambulance or land ambulance
transportation.
2. The Contractor shall be responsible for on-site emergency medical
treatment for Department employees, visitors, and contractors injured or
who become ill while working at the institution, consisting of
stabilization and referral to personal physician or local hospital,
consistent with the current Policy and Procedure on Emergency Treatment of
Staff and Visitors.
3. The following service requirements shall be met to ensure that appropriate
emergency treatment is provided:
a. In-service education on first aid and emergency procedures.
b. Written policies and procedures concerning emergency transfer and
transportation of inmates.
c. Arrangements for emergency 24 hour on-call physician coverage.
d. Coordination with security for arrangements when the emergency transfer
of an inmate is indicated.
e. Cardiopulmonary Resuscitation (CPR) Basic Training for all Health
Services staff and other designated staff members.
P. Laboratory Services
1. The Contractor shall provide medically necessary and appropriate
diagnostic laboratory procedures.
2. All STAT laboratory work shall be performed at a local hospital or
accredited laboratory nearest the institution. Results shall be telephoned
immediately to the requesting physician and a written report shall follow
within 24 hours.
3. The Contractor shall be financially responsible for all laboratory
services. Non-urgent laboratory services may be provided to the
institution by the Department's laboratory services contracted provider or
by the Contractor under a written subcontracting arrangement with a
provider approved by the Department. The most cost-effective process may
be utilized subject to prior Office of Health Services' approval. The
subcontracted laboratory must, however, be in compliance with all
applicable requirements of Chapter 483, Florida Statutes, including
Sections 483.011, 483.26 and 483.800 through 483.827. If the Contractor
provides any in-house laboratory testing, it must also be in compliance
with the appropriate provisions of Florida law. If only waived tests are
conducted, the Contractor must obtain a Certificate of Exemption from the
Agency for Healthcare Administration and prior approval of the Contract
Manager.
Generally, laboratory services shall include:
a. Laboratory supplies and required equipment (i.e., centrifuges).
b. Pick-up and delivery on a daily basis, or as-needed Monday through
Friday.
c. Printer installed at the institution, to provide test results
(FACSIMILE NOT ACCEPTABLE).
d. Immediate telephone contact with written reporting capability within 24
hours.
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4. The Contractor shall provide a physician who shall check,
initial and date all laboratory results within an appropriate
time, not to exceed 24-hours (weekends excluded) to assess the
follow-up care indicated and to screen for discrepancies
between the clinical observations and the laboratory results.
In the event that the laboratory report and the clinical
condition of the patient do not appear to correlate, it shall
be the responsibility of the physician to make a clinical
assessment, and to provide appropriate follow-up, which may
include reordering of the lab tests, when necessary, for
reconciliation.
Q. Radiology Services
1. The Contractor shall provide medically necessary and
appropriate diagnostic X-ray procedures.
2. The Contractor shall be financially responsible for all
radiology services. Routine x-rays may be provided on-site if
the Contractor elects to equip and maintain an x-ray
department, since the Department does not own any x-ray
equipment. If the Contractor chooses not to equip an x-ray
department, the Contractor may provide routine or non-urgent
x-rays through the Department's contracted provider or under a
written subcontracting arrangement with a provider approved in
writing by the Department. The most cost-effective process may
be utilized subject to the prior approval of the Contract
Manager. All services shall be provided in accordance with
applicable state and local regulations for equipment and
personnel licensure.
3. The Contractor shall provide all fluoroscopy, magnetic
imaging, CAT scan, ultrasound and other special studies for
all inmates.
4. The Contractor shall ensure that x-ray films are read by a
radiologist. The radiologist shall call the institution's CHO
with any report requiring immediate intervention. The
Contractor shall ensure that a written report, on form
DC4-705A, is forwarded to the institution within 24 hours of
interpretation of the films. All emergency x-rays that are
required at times other than normal working hours shall be
performed at a local facility. A physician shall review,
initial and date all x-ray reports within five (5) days.
R. Biohazardous Waste Disposal
The Contractor shall provide and be financially responsible for
meeting all bio-hazardous waste disposal requirements including
implementation of appropriate storage procedures, transport of
medical, bio-hazardous waste to appropriate institution pick-up
point, and transport away from each institution, in compliance with
all applicable State and local laws, rules and regulations, and the
Department's procedures, Chapter 00X-00, Xxxxxxxxxxxx Xxxxx, Xxxxxxx
Administrative Code and Standards of the Medicare Program.
S. Disasters
1. Within one hundred twenty (120) days from the effective date
of the Contract and subject to the Warden's approval, the
Contractor's administrator at each institution shall develop
and maintain for contract monitoring review, procedures to be
employed by the respective institution for the delivery of
comprehensive healthcare services in the event of a disaster
such as fire, tornado, epidemic, riot, strike or mass arrests.
This "Institutional Health Service Disaster Plan" shall be
developed, and/or instituted by the Contractor's institutional
administrator working closely with the Warden or his/her
designee. The Contractor's plan shall include, but not be
limited to:
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a. Establishment of communications system;
b. Recall of key staff;
c. Assignment of healthcare staff;
d. Establishment of command post;
e. Safety and security of the patient and staff areas;
f. Use of emergency equipment and supplies;
g. Establishment of a triage area;
h. Triage procedures;
i. Medical records - identification of injured;
j. Use of ambulance services;
k. Transfer of injured to local hospitals;
1. Evacuation procedures (to be coordinated with security
personnel); and
m. Practice drills which shall be conducted annually.
2. In addition, the Contractor shall provide a Familiarization
Staff Training Program within 120 days from the effective date
of the contract for all healthcare employees in case of an
institutional emergency, such as riot, hostage events, or
escape. Institutional emergencies shall be handled in the
following manner:
a. All in-house measures for dealing with the emergency
shall be taken.
b. As appropriate to the nature of the emergency, the
Institutional Health Services Disaster Plan as discussed
above shall be put into effect.
In case of natural disasters, such as hurricanes, which are
beyond the control of the Contractor, the Department may
contract for or provide medically necessary services resulting
from the natural disaster with any healthcare provider,
including the Contractor. Rates of reimbursement for these
services, if necessary, will be negotiated with the Contract
Manager.
T. Inmate Health Education
The Contractor shall implement within ninety (90) days of contract
execution, subject to Department approval, an inmate health
education program. To promote the health education process,
informational programs shall be made available based on the
requirements of Florida Statutes and assessed educational needs of
the inmates. Selected topics for these programs may include but are
not limited to:
1. Personal hygiene;
2. Nutrition;
3. Physical fitness;
4. Stress management;
5. Sexually transmitted diseases;
6. Chemical dependency;
7. Tuberculosis and other communicable diseases;
8. Effects of smoking;
9. HIV/AIDS;
10. Hypertension/Cardiac;
11. Epilepsy;
12. Diabetes;
13. Dermatology;
14. Rehabilitation; and
15. Prison Rape Elimination Act (PREA).
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U. Inmate Grievances/Complaints
Inmates have the opportunity to file grievances about any aspect of
their incarceration, including healthcare. Any grievances filed by
inmates regarding healthcare shall be referred to the CHO or his/her
designee, who shall review the claim and gather information
concerning the complaint, and take appropriate action consistent
with institutional grievance procedures (HSB 15.02.01) and Chapter
33-29, Florida Administrative Code. Upon request for information
from the Office of Health Services or the Contract Manager, the
Contractor shall furnish all information provided in response to the
grievances. Information shall be provided in a timely manner. Those
grievances not satisfied at the institutional level can be appealed
by the inmate to the Office of Health Services for resolution. A
high number of appeals upheld at this level would indicate a
problem/breakdown with the grievance process at the institutional
level and a possible weakness in the delivery of appropriate and
medically necessary healthcare. Responses to requests for
information are to be complete and accurate addressing all aspects
of the complaint.
V. Inmate Transfers
1. All inmate transfers shall be screened, evaluated, and
documented, as required by the applicable Technical
Instruction, by medical personnel immediately prior to
transfer or upon arrival at the receiving facility. The
preliminary screening shall include, but is not limited to:
a. Inquiry into:
1) Current illness
2) Communicable diseases
3) Alcohol/chemical abuse history
4) Medications currently being taken
5) Dental status
6) Chronic health problems
b. Observation of:
1) State of consciousness
2) Mental status
3) Appearance
4) Conduct
5) Bodily deformities and ease of movement
6) Signs of trauma, bruises, lesions, jaundice,
rashes and infestations, and needle marks or other
indications of drug abuse.
2. Explanation of procedures for access to health services shall
be provided to inmates both orally and in writing via the
inmate handbook. The handbook will be provided by the
Department.
3. The findings of the preliminary screening and evaluation,
including the medical classification of the inmate, shall be
recorded on a Department-approved screening form and entered
into the inmate's medical record.
4. If either party (Department or Contractor) has reason to
believe that an inmate has been inappropriately transferred by
reason of medical condition, that party will provide a
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report within 72 hours of receipt of the inmate at the
institution, including name, number and circumstances to the
other party, with a copy of the report forwarded to the
Contract Manager. The Contract Manager will investigate and
reply as appropriate, in accordance with the contract
communications procedure.
W. Medical Library
The Contractor is required to establish a medical library on-site at
each institution for use by the healthcare staff. To that end, any
existing medical library at an institution will become the
responsibility of the Contractor. The library shall contain, at a
minimum, basic reference texts related to diagnosis and treatment in
a primary care setting, as well as a current medical dictionary, all
statutorily required pharmacology reference books, and a current
Physicians' Desk Reference. Upon request of the Contractor and at
the Contractor's expense, the Department will provide Department
resource materials (i.e. HSB's/TI's, etc), to the Institutional
Health Services Administrator.
X. Healthcare Records
The Contractor shall ensure that all healthcare unit staff documents
each healthcare encounter in the appropriate section of the
Problem-Oriented Medical Record, utilizing the XXXXX format,
including specific Department of Corrections' approved forms as
outlined in Department of Corrections' Rules, (Chapters 33-6, 33-19,
Florida Administrative Code), pertinent Health Services' Bulletins,
and Florida Statutes.
1. The Contractor shall ensure that each inmate's medical record
including the Medication Administration Record, is complete,
accurate and contains sufficient documentation to warrant the
treatment rendered, and that each entry is made in a timely
manner to comply with all aforementioned procedures.
2. The Contractor shall ensure specific compliance regarding
confidentiality and medico-legal access/disclosure, shall
assist in providing documentation to support Department
automation, and shall participate in the Department's Quality
Management Program.
3. The Contractor shall ensure that each medical record meets the
requirements of Florida Statutes and the Department's
procedures, HSB's and TI's, as applicable.
4. The Contractor shall ensure that all logs required in medical
areas are maintained in a complete, current and accurate
condition. The Contractor shall ensure that the weekly and
monthly validations (signatures by the Chief Health Officer or
the Contractor's Designee) are accomplished prior to the fifth
(5th) day of the following month.
NOTE: It is the intent of the Department to adapt an existing
automated medical record system for use at all institutions in
Florida. A timeframe for this adaptation has not been determined at
this time. Accordingly, the Contractor will be required to be
compliant with the requirements of this system at such time as it is
implemented.
Y. Contractor's Staffing
1. General Administrative Requirements:
The Contractor shall have direct oversight, be responsible for
and monitor the performance of all healthcare staff whether
providing direct healthcare or performing
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other duties in support of the Contract. The Department will
provide security for the Contractor's employees and agents
consistent with the security provided at other Department
facilities.
The Contractor shall provide an adequate level of staffing for
provision of the services outlined herein and shall ensure
that staff providing services is appropriately trained and
qualified and licensed, as appropriate. Staff shall provide
professional healthcare coverage twenty-four (24) hours a day,
seven (7) days a week for the institution.
Additionally, the Contractor's staff shall liaise with and
maintain a good working relationship with Department staff and
other providers working with the Department.
The Contractor shall distribute a written job description to
each member of the Contractor's staff that clearly delineates
their assigned responsibilities. The job description shall be
signed by the employee and supervisor and maintained in the
on-site personnel file. The Contractor shall annually evaluate
performance of healthcare staff to ensure adequate job
performance in accordance with these job descriptions and
other provisions of this Contract and such performance
evaluations shall be maintained in the on-site personnel
files. The Contract Manager shall be advised of any
Contractor's employee who receives a less than satisfactory
evaluation.
The Contractor shall maintain personnel files on all contract
employees in the healthcare unit of the institution. The
records shall be made available to the Healthcare Contract
Monitor, Institutional Warden or designee, and the Director of
Health Services-Administration or designee. These files shall
include, but not be limited to, copies of current Florida
licenses or proof of professional certification, and
evaluation records and position responsibilities.
If any Department healthcare employee is adversely affected by
this privatization initiative, the Contractor shall give
Department healthcare employees first consideration for
employment
The Contractor shall ensure that all staff performing services
under this Contract or regularly accessing the Department's
institutions is TB screened and/or tested as required by
Department Procedure 401.015, Employee TB Screening and
Testing.
The Contractor shall provide its physicians with cell phones
so that they may be contacted while off-site.
The final selection of all staff assigned to provide services
under this Contract shall be subject to approval by the
Department. Department employees terminated at any time by the
Department for cause may not be employed or provide services
under the Contract. The Department shall not employ criteria
to approve or disapprove the selection of Contract employees
that exposes the Contractor or the Department to civil or
criminal liability under applicable federal or state civil
rights laws, including, but not limited to, those laws
establishing or protecting employee rights.
Current state employees subsequently hired by the Contractor
shall maintain current security clearances and professional
credentials, when appropriate.
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2. Staffing Plan and Levels:
The Department has not established in this Contract, any
required staffing levels based on inmate-to- healthcare staff
ratios.
Two (2) weeks prior to the scheduled implementation date for
each institution, the Contractor shall provide a staffing
roster to the Contract Manager and to the Health Services'
Administrator for the respective facility. The roster will
include the name and position, title and licensure status for
each Contractor's staff member. When applicable, a copy of the
corresponding executed supervision agreement required by
applicable Florida laws shall be attached.
3. Contractor Key Staff Administrative Positions and
Responsibilities:
The Contractor shall provide the following minimum key
administrative staff positions in support of this contract:
a. CHIEF EXECUTIVE OFFICER (OR EQUIVALENT TITLE): The Chief
Executive Officer is the highest ranking officer in the
Contractor's company or organization. The CEO shall have
a minimum of one (1) years' experience as CEO.
b. ADMINISTRATIVE PROJECT MANAGER (OR EQUIVALENT TITLE):
The Project Manager is the individual who will have
corporate responsibility for administration of the
contract. This individual shall have a minimum of three
(3) years' experience within the last ten (10) years at
the management level, providing direct administrative
oversight of a large-scale health-related program in a
correctional system comprised of 10,000 inmates.
c. HEALTHCARE SERVICES PROGRAM DIRECTOR (OR EQUIVALENT
TITLE): The Healthcare Services Program Director is the
individual providing clinical oversight for all
institutions. This individual is responsible for
directing overall healthcare services delivery to
include oversight of all healthcare services staff,
consulting with other healthcare discipline staff and
coordination of healthcare services with other
healthcare providers. This individual shall have a
minimum of three (3) years' experience within the last
ten (10) years at the management level, directly
managing a correctional medical services program or
component within a correctional system comprised of
10,000 inmates in all medical grades up to and including
inpatient status. In addition, the person occupying this
position must be licensed "in good standing" to practice
medicine as required under Chapter 458 or 459, Florida
Statutes, hold a current DEA Registration Number, and
must have credentials that meet or exceed the
requirements of Florida Law.
d. CHIEF HEALTH OFFICER (CHO) (OR EQUIVALENT TITLE) FOR
EACH INSTITUTIONAL SITE: The on-site CHO at each
institution shall serve as the medical authority and
shall work as a team with the Contractor's
administrative and clinical managers. Each CHO shall
operate the clinical healthcare program in accordance
with the standards set forth in Sections II., B., and
II., C., and all applicable State and Federal Laws,
Rules and Regulations; Departmental Rules, Policies and
Procedures; Health Services Bulletins/Technical
Instructions; and ACA standards, and shall adhere to any
additions or changes thereto. Each on-site CHO shall
plan, implement, direct and control all clinical aspects
of the institutional healthcare program and shall have
direct oversight of and shall monitor the performance of
all healthcare personnel
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rendering direct patient care. The on-site CHO shall
also provide primary healthcare services on a routine
basis and meet the same standards as other CHOs in the
Department. In addition, the person occupying this
position must be licensed to practice medicine under FS
458 or 459 in the State of Florida "in good standing",
hold a current DEA Registration Number, and must have
credentials that meet or exceed the requirements of
Florida Law.
e. MENTAL HEALTH PROGRAM DIRECTOR (OR EQUIVALENT TITLE):
The Mental Health Program Director is the individual
providing clinical oversight for all included
institutions. This individual is responsible for
directing overall mental healthcare service delivery to
include oversight of all mental healthcare staff,
consulting with other medical staff and coordination of
mental health services with other healthcare providers.
The person occupying this position must be licensed to
practice psychology or medicine "in good standing" in
the State of Florida and must have credentials that meet
or exceed the requirements of Florida Law. If the person
occupying this position is a physician, s/he must hold a
current DEA Registration Number and be either board
eligible or board certified in psychiatry.
f. DENTAL SERVICES PROGRAM DIRECTOR (OR EQUIVALENT TITLE):
The Dental Services Program Director is the individual
providing clinical oversight for all included
institutions. This individual is responsible for
directing overall dental healthcare service delivery to
include oversight of all dental healthcare staff,
consulting with other healthcare staff and coordination
of dental services with other healthcare providers. The
person occupying this position must be licensed to
practice dentistry "in good standing" in the State of
Florida, hold a current DEA Registration Number, and
must have credentials that meet or exceed the
requirements of Florida Law.
g. PHARMACY PROGRAM DIRECTOR (OR EQUIVALENT TITLE): The
Pharmacy Program Director is the individual providing
clinical oversight for all institutions. This individual
is responsible for directing overall pharmacy service
delivery to include oversight of all pharmacy staff,
consulting with other healthcare staff and coordination
of pharmacy services with other healthcare providers.
The person occupying this position must be licensed to
practice pharmacy in the State of Florida and must have
credentials that meet or exceed the requirements of
Florida Law.
h. INSTITUTIONAL HEALTHCARE ADMINISTRATOR (OR EQUIVALENT
TITLE) for Each Institutional Site: The on-site
Institutional Healthcare Administrator at each
institution shall serve as the Contractor's point of
contact with the Warden for all institutional healthcare
matters and shall work as the healthcare manager,
coordinating delivery of all non-clinical health
services support. Each Institutional Healthcare
Administrator shall perform in accordance with the
standards set forth in the contract and all applicable
State and Federal Laws, Rules and Regulations;
Departmental Rules, Policies and Procedures; Health
Service Bulletins/Technical Instructions; and ACA
standards, and shall adhere to any additions or changes
thereto. Each on-site Institutional Healthcare
Administrator shall plan, implement, direct and control
all non-clinical aspects of the institutional healthcare
program and shall have direct oversight of and shall
monitor the performance of all healthcare personnel
supporting the delivery of non-clinical healthcare. This
individual shall also perform to the same standards as
the Department's Institutional Health Services
Administrators.
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i. DIRECTOR OF NURSING (OR EQUIVALENT TITLE): The Director
of Nursing (DON) is the professional level Registered
Nurse providing nursing oversight for all included
institutions. This person shall administer, supervise,
and coordinate the nursing program. The Director of
Nursing shall have as a minimum, three (3) years of
correctional Nursing Director or Supervisor experience
within the last ten (10) years for multiple jails having
a total inmate population of no less than 5,000 for the
entire year; or three (3) years, correctional Nursing
Director or Supervisor experience within the last ten
(10) years for one or more institutions at the state
prison system level or the same experience at the
federal prison system level or similar facility such as
a military prison.
4. Healthcare Staff Positions' Job Functions
To ensure the provision of comprehensive healthcare services
as specified in this Contract, the Contractor will be
responsible for utilizing qualified, licensed "in good
standing" (where appropriate), and supervised staff, including
any necessary specialized support staff, as determined by the
Contractor, for each of the four specific disciplines included
in this Contract. Staff experience, qualifications and job
functions should be as specified within this Contract and, in
addition, shall be consistent with health industry standards.
In addition, due to specific requirements of correctional
mental health service delivery, the Contractor shall
specifically provide mental health services staff as outlined
below:
a. Mental Health Services Staff Positions
The Contractor shall provide mental health staff that
includes licensed clinical staff (psychiatrists,
psychiatric ARNPs, nurses, psychologists, and
psychological specialists) as well as qualified and
specialized support staff including institutional
counselors and human services counselors. Whereas
supervised support staff can provide adjunctive mental
health services (e.g., coordinating aftercare, inpatient
recreation therapy and social skills training), only
licensed clinical staff may provide mental health
services involving a clinical diagnosis and/or treatment
disposition.
The Contractor will be responsible for utilizing
appropriately licensed and supervised staff as
determined by the Contractor for the accomplishment of
the following job functions outlined below:
1) Senior Psychologist (or equivalent title).
Psychologists shall perform services on an
outpatient or inpatient basis depending upon
assignment.
The primary responsibility of an outpatient
psychologist is the provision of clinical services
and the coordination of all aspects of mental
health services made available to the inmate
population at his/her institution, from initial
screening to aftercare (post-release service)
planning.
In consultation with psychiatry, inpatient unit
Senior Psychologists shall be accountable for the
implementation and coordination of all mental
health services within the operational unit.
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Regardless of the setting, the Senior
Psychologist shall function within the
health services unit under the supervision
of the Chief Health Officer (CHO) and shall
be accountable to the CHO and the warden for
all programmatic and operational aspects of
mental healthcare service delivery.
The Senior Psychologist shall be responsible
for the following minimum responsibilities:
a) maintenance of a clinical caseload;
b) a minimum of one hour of documented
individual clinical supervision of
each psychological services provider
weekly;
c) implementation of Procedure Manuals
and Health Services'
Bulletins/Technical Instructions;
d) documenting compliance with ongoing
Corrective Action Plans (CAPs);
e) serving as advisor to the warden on all
mental health services-related operational
and programmatic issues;
f) reviewing and authorizing referrals for
psychiatric services;
g) reviewing initial inmate requests for mental
health services on a daily basis;
h) reviewing selected entries made in inmate
health records on a daily basis, focusing on
the quality of 1) service planning, 2) case
management notes, 3) group notes for each
psychological specialist and 4) individual
therapy notes;
i) reviewing randomly selected health records
on a weekly basis, checking more
specifically on entries made by psychiatric
services;
j) overseeing the process of psychological
examinations, including review of test
findings, and signs evaluations written for
the Florida Parole Commission and ICO
requests;
k) acting as a consultant in mental health
services-related matters to other
institutional units;
l) making available to the inmate population a
variety of psychotherapeutic modalities
based on inmate psychological, mental, and
behavioral needs as determined by a periodic
review of the inmate population profile;
m) attending institutional and regional
meetings as directed by the warden and/or
the Chief Health Officer; and
n) monitoring mental health staff productivity
to ensure that workloads are adequate and
care is provided in accordance with the
Procedure Manuals and HSBs/Technical
Instructions.
2) Senior Physician-Psychiatrist (or equivalent
title)
The Senior Psychiatrist is the multidisciplinary
member that shall be ultimately responsible for
patient diagnosis and pharmacotherapy, as well as
those psychiatric functions consistent with
clinical practice appropriate to the specialty.
3) RN Specialist
The RN Specialist shall provide medication and
general health information to inmates. She/he
shall be a member of the multidisciplinary team
providing information regarding medication
response, health status, and observed behaviors.
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The RN Specialist shall be responsible for:
a) health teaching;
b) medication information in groups and
individually;
c) monitoring medication compliance and lab
results;
d) coordinating physical and mental health
services;
e) crisis intervention; and
f) when necessary, sick call for inpatient
units.
4) Psychological Specialist
Staff psychological specialists shall provide the
majority of direct mental healthcare services to
inmates and shall be responsible for the minimum
responsibilities:
a) serving as case manager and is responsible
for the maintenance of a clinical caseload;
b) writing the Individualized Service Plan
(ISP) with input from the inmate;
c) ensuring that the ISP is implemented,
reviewed, and revised in a timely manner;
d) verifying that the ISP reflects inmate
progress on problems and successful
interventions until such time as the inmate
is able to demonstrate adequate adjustment
to incarceration;
e) in conjunction with the Senior Psychologist,
delivering and managing the inmate's
selected mode of psychotherapy;
f) ensuring the inmate receives all necessary
care including notifying the supervisor of
an inmate's needs when necessary;
g) ensuring transition planning is completed
and effectively implemented through
coordination with the Department of Children
and Families' District Coordinators.
h) under the supervision of the Senior
Psychologist, and depending on credentialing
privileges, administering various
psychological tests including those designed
to measure adequate functioning in the areas
of organicity, intelligence, and
personality; and
i) serving as a link to community mental health
centers and the Department of Health for
inmates who were treated for psychiatric
disorder while incarcerated and who, at the
time of release, are assessed by the
psychiatrist as needing post-release
treatment.
Once the inmate has demonstrated adjustment to
incarceration, and does not necessarily require
ongoing services to maintain the Psychological
Specialist shall discontinue all planned treatment
and close the ISP. The Psychological Specialist
shall comply with time frames for services
planning and other case management
responsibilities as detailed in HSB 15.05.05, HSB
15.05.11, and TI 15.05.18.
The Psychological Specialist/Case Manager shall
function under the supervision of a Senior
Psychologist, and shall render mental health
services only within the guidelines and standards
defined by applicable laws and administrative
rules, professional review boards or associations,
Department policies and procedures, and HSBs/TIs.
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5) Institutional Counselors and Human Services
Counselors
Institutional Counselors and Human Services
Counselors shall function under the supervision of
the Senior Psychologist and have the following
responsibilities:
a) administer group intelligence tests;
b) serve as a link with community mental health
centers and the Department of Health for
inmates who were treated for psychiatric
disorder while incarcerated and who, at the
time of release, are assessed by the
psychiatrist as needing post-release
treatment;
c) provide required scheduled services in
inpatient units. Such services are limited
to psycho-educational groups, recreation
therapy, social skills training, and other
activities that do not incorporate clinical
services; and
d) provide inmate orientation, suicide
prevention training, and other mental health
related training.
5. Healthcare Staff Credentials
The Contractor shall employ only those persons having
appropriate Florida licensure and certification and who have
provided documentation of past healthcare experience.
Individuals in positions that require credentials (Physicians,
Advanced Registered Nurse Practitioners (ARNPs) Psychologists,
Psychological Specialists and any other position that requires
credentials), will be subject to a credentials review by the
Department to ensure that the individual has the requisite
training, experience and licensure or certification necessary
to perform the duties assigned. It is the Contractor's
responsibility to ascertain and comply with all state
licensing and credentialing requirements.
The Contractor shall comply with the credentialing
requirements in HSB 15.09.05 including utilization of
appropriate Department forms and packet format and an
equivalent approval process. All credentials files shall be
prepared and completed by the Contractor within the designated
time frames established by the HSB/TI, and shall be approved
through the Contractor's highest level of review and submitted
to the Contract Manager/Credentials Coordinator of the
Department for final review and acceptance at the Quarterly
Credentials Meeting. Completed credentials packets shall be
maintained by the Contractor with a copy retained by the
Department.
The Contractor shall also provide a certification statement on
each individual to the Director of Health Services certifying
that the credentials of each individual have been reviewed and
that he/she is certified as fully qualified to perform the
duties assigned. All credentials must meet or exceed the
requirements of Florida Law.
The final selection of all staff assigned to provide services
under this Contract shall be subject to approval by the
Department. Department employees terminated at any time by the
Department for cause may not be employed or provide services
under the Contract. The Department shall not employ criteria
to approve or disapprove the selection of Contract employees
that exposes the Contractor or the Department to civil or
criminal liability under applicable federal or state civil
rights laws, including, but not limited to, those laws
establishing or protecting employee rights.
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The Contractor shall notify in writing and consult with the
Warden or designee and the Director of Health
Services-Administration or designee prior to discharging,
removing or failing to renew the contracts of, professional
staff. A copy of the notification shall be provided by the
Contractor to the Contract Manager.
Current state employees subsequently hired by the Contractor
shall maintain current security clearances and professional
credentials.
6. Staff Conduct
The Contractor's staff on-site shall adhere to the standards
of conduct prescribed in Chapter 33-208, Florida
Administrative Code, and as prescribed in the Department's
personnel policy and procedure guidelines, particularly rules
of conduct, employee uniform and clothing requirements (as
applicable), security procedures, and any other applicable
rules, regulations, policies and procedures of the Department.
The Contractor's staff shall be subject to and shall comply
with all security regulations and procedures of the Department
and the institution. Violation of regulations may result in
the employee or individual being denied access to the
institution. In this event, the Contractor shall provide
alternate personnel to supply services described herein,
subject to Department approval.
In addition, the Contractor shall ensure that all staff
adheres to the following requirements:
The Contractor's staff shall not display favoritism to, or
preferential treatment of, one inmate or group of inmates over
another.
The Contractor's staff shall not deal with any inmate except
in a relationship that supports services under this Contract.
Specifically, staff members must never accept for themselves
or any member of their family, any personal (tangible or
intangible) gift, favor, or service from an inmate or an
inmate's family or close associate, no matter how trivial the
gift or service may seem. The Contractor shall report to the
Contract Manager any violations or attempted violation of
these restrictions. In addition, no staff member shall give
any gifts, favors or services to inmates, their family or
close associates.
The Contractor's staff shall not enter into any business
relationship with inmates or their families (example -
selling, buying or trading personal property), or personally
employ them in any capacity.
The Contractor's staff shall not have outside contact (other
than incidental contact) with an inmate being served or their
family or close associates, except for those activities that
are to be rendered under the Contract.
The Contractor's staff shall not engage in any conduct which
is criminal in nature or which would bring discredit upon the
Contractor or the State. In providing services pursuant to
this Contract, the Contractor shall ensure that its employees
avoid both misconduct and the appearance of misconduct.
Any violation or attempted violation of the restrictions
referred to in this section regarding employee conduct shall
be reported by phone and in writing to the Contract Manager or
their designee, including proposed action to be taken by the
Contractor. Any failure to report a violation or take
appropriate disciplinary action against the
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offending party or parties shall subject the Contractor to
appropriate action, up to and including termination of this
Contract.
The Contractor shall report any incident described above, or
requiring investigation by the Contractor, in writing, to the
Contract Manager or their designee within twenty four (24)
hours, of the Contractor's knowledge of the incident.
7. Staff Background/Criminal Record Checks
The Contractor's staff assigned to this Contract shall be
subject, at the Department's discretion and expense, to a
Florida Department of Law Enforcement (FDLE) Florida Crime
Information Center/National Crime Information Center
(FCIC/NCIC) background/criminal records check. This background
check will be conducted by the Department and may occur or
re-occur at any time during the Contract period. The
Department has full discretion to require the Contractor to
disqualify, prevent, or remove any staff from any work under
the Contract. The Department is under no obligation to inform
the Contractor of the records check findings or the criteria
for disqualification or removal. In order to carry out this
records check, the Contractor shall provide, upon request, the
following data for any individual Contractor or
subcontractor's staff assigned to the Contract: Full Name,
Race, Gender, Date of Birth, Social Security Number, Driver's
License Number and State of Issue. Upon request of the
Department, the Contractor's staff shall submit to
fingerprinting by the Department of Corrections for submission
to the Federal Bureau of Investigation (FBI). The Contractor
shall not consider new employees to be on permanent status
until a favorable report is received by the Department from
the FBI.
The Contractor shall ensure that the Contract Manager or
designee is provided the information needed to have the
NCIC/FCIC background check conducted prior to any new
Contractor staff being hired or assigned to work under the
Contract. The Contractor shall not employ any individual or
assign any individual to work under the Contract, who has not
had an NCIC/FCIC background check conducted.
No person who has been barred from any Department work release
center or other facility shall provide services under this
Contract at another Department facility.
The Contractor shall not permit any individual to provide
services under this Contract who is under supervision or
jurisdiction of any parole, probation or correctional
authority. The objective of this provision is to ensure that
no employee of the Contractor, under any such legal
constraint, has contact with or access to any records of
Department of Corrections' inmates sentenced to sites included
under this Contract.
Note: A felony or first-degree misdemeanor conviction, a plea
of guilty or nolo contendere to a felony or first-degree
misdemeanor crime, or adjudication of guilt withheld to a
felony or first-degree misdemeanor crime does not
automatically bar the Contractor from hiring the proposed
employee. However, the Department reserves the right to prior
approval in such cases. Generally, two (2) years with no
criminal history is preferred. The Contractor shall make full
written report to the Contract Manager within three (3)
calendar days whenever one of their employees has a criminal
charge filed against them or arrest or receives a Notice to
Appear for violation of any criminal law involving a
misdemeanor or felony, or ordinance except minor violations
for which the fine or bond forfeiture is $200 or less or has
knowledge of any violation of the law rules, directives or
procedures of the Department.
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8. Contractor Staff Training and Education
The Contractor is responsible for ensuring that all healthcare
staff is provided the following training: (Note: The
Contractor is not required to duplicate training for employees
previously (within the last year) employed by the Department.)
a. Orientation and appropriate training regarding on-site
security and medical practices at each institution.
Additionally, the CHO shall receive the same orientation
training given to other CHOs by the Office of Health
Services.
b. One-time mandatory training (as prescribed for all
Department employees), including forty (40) hours of
orientation training. The provision of this training
will be the responsibility of the applicable
institution. The Contractor will ensure all healthcare
employees receive this training.
c. Annual in-service training (as prescribed for all
Department employees). All full-time health staff shall
receive forty (40) hours of in-service training per year
with the exception of clerical, who shall receive twenty
(20) hours. This training must include the Mandatory
Skills Maintenance Training prescribed by the Department
that is appropriate to the respective position class.
Selected topics that require staff training shall be
identified on an on-going basis through the Office of
Health Services, Clinical Quality Management Program.
d. Additionally, the Contractor shall ensure that all staff
performing services under the Contract at institutional
sites is trained in the following areas:
1) Cardiopulmonary Resuscitation (CPR);
2) First aid;
3) Response to medical emergency or disaster;
4) Recognizing signs and symptoms of mental disorders
or chemical dependency;
5) HIV/AIDS;
6) Suicide prevention;
7) Additional topics as required and approved by the
Department's Director of Health Services; and
8) Prison Rape Elimination Act (PREA)
Z. Information Technology
1. Information Technology (IT) Systems and Equipment
The Contractor will use the Department's existing information
systems to collect, store and report on daily Health Services'
operations. This includes, but is not limited to, entering
data, monitoring reports and screens and auditing data for
accuracy to keep current the Offender Based Information System
(OBIS) - Health Services (HS) component, plus any other
department system or component developed for Health Services
or any department system or component deemed necessary for
Health Services operations. Any changes required to the
Department's existing system to maintain the Contractor's
operational interfaces, usability and data sharing must be
approved by the Department, made by Department staff and paid
for by the Contractor.
Should the Contractor wish to use a system that is different
from systems provided by the Department, the system, its
technical environment, the data required and collected,
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CONTRACT C2297
and its use must be approved, at the sole discretion of the
Department, by the Department's Office of Health Services and
the Office of Information Technology. Such system must be
compatible with current Department and State Technology Office
information technology software and security architectural
standards. Any such system may also be required by the
Department to be used by its other partners in providing
health services and to facilitate this application sharing may
require that the solution actually be installed on Department
computers. Any new system will be subject to management
control by the Department.
The Contractor shall utilize and maintain the Department's
basic component of Information Technology (IT) equipment (as
used herein, the term "equipment" does not include software)
available at each institution. If the Contractor determines
the need for additional or updated equipment to ensure
Contract compliance, other than as a result of the
Department's expansion of programs or due to population
increases, such equipment shall be the responsibility and
shall be provided at the expense, of the Contractor. All
equipment is to be compatible with current State Technology
Office information technology hardware/software architectural
standards. Any additional IT equipment required by the
Department will be the responsibility of and provided at the
expense of the Department.
2. OBIS System Use and Training
The Contractor will make available appropriate personnel for
training in the Health Services' component of the Offender
Based Information System (OBIS-HS). Training will be provided
by the Department and will be conducted in Olustee, Florida or
at each institution, if possible. Personnel required to attend
include the Data Entry Operators and any personnel entering or
assessing data in the OBIS-HS system. The Contractor is
responsible for payment of travel expenses for its employees.
The Contractor shall ensure that sufficient employees from
each institution complete this training within the first
ninety (90) days of the Contract. Failure of the Contractor to
provide sufficient personnel for training is not an acceptable
reason for not maintaining OBIS information current and as
noted earlier such failure shall be deemed breach of Contract.
AA. Reporting Requirements
1. COST REPORT: The Contractor shall provide to the Contract
Manager and the Director of Health Services, Administration,
quarterly (calendar year), no less than fifteen business days
after the end of each contract quarter, a report of its
operating costs for each institution. These cost reports
should be submitted in a format approved by the Contract
Manager. Any changes made to this format by the Department
during the term of the contract shall also be made by the
Contractor.
2. QUALITY MANAGEMENT REPORTS: The Contractor shall ensure all
Clinical Quality Management Reports as further described in
Quality Management Technical Instruction series, including
Infectious Disease and Mortality Review reporting, are
properly completed and submitted as directed in the respective
Technical Instruction, to the Contract Manager and Quality
Management section in Central Office-Office of Health
Services.
3. PHARMACY SERVICES REPORTS: The following reports shall be
submitted to the Department's Director of Pharmacy Services by
the 10th day of the month, following each month of service,
with a copy to the Contract Manager.
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a. MONTHLY MEDICATION SUMMARY REPORT: The Contractor will
provide a monthly medication summary report that
includes but is not limited to, the following monthly
data:
1) top 200 medications issued;
2) total number of mental health prescriptions issued
along with total cost of mental health medications
(includes stock issued);
3) total number of HIV/AIDS prescriptions issued
along with total cost of HIV/AIDS medications
issued (includes stock issued);
4) total number of Hepatitis and Tuberculosis
prescriptions issued and the total cost of the
Hepatitis and Tuberculosis medications (includes
stock issued);
5) total number of prescriptions issued and the total
cost of all medications issued; and
6) number of medication errors and a summary report
of those errors.
b. MONTHLY NON-FORMULARY MEDICATION REPORT: The Contractor
will provide a monthly summary report of all
non-formulary medications issued for the month,
including but not limited to, the following monthly
data:
1) name of non-formulary medication;
2) prescribing practitioner;
3) cost of non-formulary medication; and
4) prescribing diagnosis.
c. MONTHLY MEDICATION COMPARISON REPORT: The Contractor
shall provide a separate monthly report indicating the
percentage of non-formulary prescriptions issued for the
month compared to the total number of prescriptions
issued.
d. ADDITIONAL PHARMACY REPORTING: Upon request of the
Department, the Contractor shall provide other reports
on medications issued and/or drug utilization. These
will generally be requested in regard to Department-wide
medication audits or legislative requests for
information. The report format shall be in EXCEL, and
the completed reports shall be sent to the Contract
Manager and the Department's Director of Pharmacy
Services.
4. The Contractor shall comply with applicable continuing
requirements as determined by the Director of Health Services,
Administration for reports to and from the Department,
Correctional Medical Authority and the Healthcare Contract
Monitor.
5. ADDITIONAL/ADHOC REPORTING REQUIREMENTS: The Department
reserves the right to require additional reports, adhoc
reports, information pertaining to Contract compliance or
other reports or information that may be required to respond
to grievances, inquiries, complaints and other questions
raised by inmates or other parties. The Contractor shall
submit the report or information in not less than seventy-two
(72) hours after receipt of the request unless such
information or report is of a type or quantity that cannot
reasonably be gathered in this time period, in which case, the
Contractor shall be given a reasonable period of time to
provide such information or report. When time is of the
essence, the Contractor will make every effort to answer the
request as soon as possible so that the Department can respond
to the authority or party making the request.
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BB. Quality Assurance Program
The Contractor shall provide a Quality Assurance Program that, at a
minimum, meets the requirements of the Department of Corrections'
Office of Health Services' Quality Assurance Program. This program
will be subject to approval by the Department's Contract Manager.
The Office of Health Services' Clinical Quality Management Program
monitors, evaluates, and improves the quality and appropriateness of
departmental healthcare processes and outcomes. The successful
bidder will actively participate and fully support the Clinical
Quality Management Program as described by the Office of Health
Services in Technical Instruction 15.09.01.
Technical Instruction 15.09.01 makes specific reference and
incorporates the technical instructions associated with
Credentialing, Mortality Review, UM, Risk Management, Peer Review,
Infection Control, Clinical Quality Assessment, Program Evaluation,
and Continuing Health Care Provider Education program components.
The successful bidder acknowledges and accepts that in the future,
the Office of Health Services from time to time may modify these
technical instructions to maintain standards of care or meet
regulatory requirements and further agrees to abide by such
modifications.
CC. Contract Termination Requirements
Upon the expiration date of the Contract, the Contractor shall
provide inventories of equipment consistent with the levels and
types of inventories provided upon Contractor's initial assumption
of services under the Contract. The Contractor shall also submit a
plan to the Contract Manager no less than thirty (30) days prior to
intended contract termination outlining steps for transition of
service upon contract expiration or in the event of contract
termination. The plan shall set forth the date and time of transfer
of responsibility by the Contractor to the entity assuming service,
with a schedule for each institution as well as a transfer plan for
any inmates in outside hospitals at the time of transition. Failure
to timely submit the transition plan shall result in forfeiture
of ten percent (10%) of the final monthly payment.
DD. Performance Measures
The Contractor shall be held accountable for the achievement of
certain performance measures in successfully delivering medical
services under this Contract. The following Performance Measure
categories shall be used to measure Contractor's performance and
delivery of services:
1. Medical Performance Outcomes and Standards;
2. Other Contract Requirements.
A description of each of the Performance Measure categories is
described below:
1. Performance Outcomes and Standards:
Listed below are the key Performance Outcomes and Standards,
by discipline, deemed most crucial to the success of the
overall desired service delivery. The Contractor shall ensure
that the stated performance outcome and standard (level of
achievement) are met.
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PERFORMANCE SHALL BE MEASURED AT EACH INSTITUTIONAL SITE, ON A
QUARTERLY BASIS, BEGINNING THE SECOND QUARTER AFTER WHICH
SERVICE HAS BEEN IMPLEMENTED.
a. Medical Services:
1) Sick Call
a) OUTCOME: Sick call will be held five days a
week, Monday through Friday, excluding State
holidays, for all inmates.
MEASURE: Sick call log and medical records
reflect sick call held Monday through Friday
every week.
CRITICAL STANDARD: Achievement of outcome
must meet one hundred percent (100%) on a
quarterly basis.
b) OUTCOME: All sick call inmates will be
triaged within 24 hours.
MEASURE: Sick call log or request form
indicates that triage is performed within 24
hours.
CRITICAL STANDARD: Achievement of outcome
must meet one hundred percent (100%) on a
quarterly basis.
c) OUTCOME: Every inmate's xxxxx xxxxx will be
checked and documented each time they attend
sick call on the appropriate assessment
form.
MEASURE: Medical record reflects xxxxx xxxxx
for each sick call inmate.
CRITICAL STANDARD: Achievement of outcome
must meet or exceed ninety-five (95) percent
on a quarterly basis.
d) OUTCOME: All Sick call entries are
documented in the medical record utilizing
the XXXXX format.
MEASURE: The medical record will have a
XXXXX entry for each sick call inmate.
CRITICAL STANDARD: Achievement of outcome
must meet one hundred percent (100%) on a
quarterly basis.
e) OUTCOME: Referrals from sick call to a
Physician or ARNP are seen within seven (7)
days.
MEASURE: DATE of referral to physician or
ARNP compared to date of sick call.
CRITICAL STANDARD: Achievement of outcome
must meet one hundred percent (100%) on a
quarterly basis.
2) Medical Specialty Consultations
a) OUTCOME: All requests for consultations are
documented on the consultation log, in the
medical record and on the blue consult
sheet.
MEASURE: The consultation log, medical
record and blue consult sheet shall reflect
all contain documentation of the request for
consultation.
CRITICAL STANDARD: Achievement of outcome
must meet one hundred percent (100%) on a
quarterly basis.
b) OUTCOME: Consultations are scheduled within
thirty (30) days of the date the request is
initiated.
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MEASURE: Date of consultation in
consultation log as compared to the date
request is initiated.
CRITICAL STANDARD: Achievement of outcome
must meet one hundred percent (100%) on a
quarterly basis.
c) OUTCOME: Consultation reports are
followed-up within seven days of receiving
the report.
MEASURE: Date of follow-up as compared to
date of receipt of report.
CRITICAL STANDARD: Achievement of outcome
must meet one hundred percent (100%) on a
quarterly basis.
3) Chronic Illness Clinics
a) OUTCOME: All problems requiring chronic
illness clinic visits are annotated on the
DC Form 0-000 Xxxxxxx List in accordance
with chronic illness guidelines.
MEASURE: The problem list will reflect
annotation for each chronic illness clinic
an inmate is in.
CRITICAL STANDARD: Achievement of outcome
must meet one hundred percent (100%) on a
quarterly basis.
b) OUTCOME: A chronic illness form is completed
for each chronic illness clinic an inmate is
in.
MEASURE: Medical record shall contain
completed chronic illness form for each
clinic inmate is enrolled in.
CRITICAL STANDARD: Achievement of outcome
must meet one hundred percent (100%) on a
quarterly basis.
c) OUTCOME: Chronic illness clinics are held as
scheduled.
MEASURE: OBIS chronic illness list will be
compared with the medical record to validate
clinic timeliness.
CRITICAL STANDARD: Achievement of outcome
must meet or exceed ninety-five percent
(95%) on a quarterly basis.
4) Medical Records
a) OUTCOME: Medical Records are current,
accurate, and chronologically maintained
with all documents filed in the designated
location.
MEASURE: Medical record shall demonstrate
that filing is chronological, properly
located and current
CRITICAL STANDARD: Achievement of outcome
must meet one hundred percent (100%) on a
quarterly basis.
b) OUTCOME: Physician's Orders in the medical
record are taken off daily, annotated with
time, date and name of the person taking
them off.
MEASURE: Comparison of dates/times of
Physician's orders with dates/times they
were taken off.
CRITICAL STANDARD: Achievement of outcome
must meet one hundred percent (100%) on a
quarterly basis.
c) OUTCOME: The Medication Administration
Record (MAR) is filed in the chart by the
5th day of the succeeding month and it is
complete in all respects.
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MEASURE: After the fifth (5th) day of the
month, medical record shall contain fully
completed MAR.
CRITICAL STANDARD: Achievement of outcome
must meet one hundred percent (100%) on a
quarterly basis.
d) OUTCOME: Medical record entries will be
legible, complete and the date, time, name
stamp and signature will attest to the
entry.
MEASURE: Medical Records shall reflect
appropriate entries.
CRITICAL STANDARD: Achievement of outcome
must meet or exceed ninety-five percent
(95%) on a quarterly basis.
5) Practitioners' Prescribing Practices
a) OUTCOME: All prescriptions will be written
in compliance with the Department's drug
formulary or will be accompanied by an
appropriate DER form.
MEASURE: Review of prescriptions to
determine whether written only for
medications on the Department's drug
formulary or pursuant to an approved Drug
Exception Request (DER) that is in the
inmate's record.
STANDARD: Achievement of outcome must meet
one hundred percent (100%) on a quarterly
basis.
b) OUTCOME: All medications will be prescribed
in therapeutic dosage ranges as determined
by the most current editions of Drug Facts
and Comparisons, Physicians' Desk Reference,
or the package insert.
MEASURE: Review of prescriptions for
compliance with therapeutic ranges or if not
within ranges, an approved DER and clinical
rational document shall be in inmate's
medical record.
STANDARD: Achievement of outcome must meet
or exceed ninety-five percent (95%) on a
quarterly basis.
c) OUTCOME: Dosages of medication will not be
changed, increased or decreased contrary to
time frames stated in the package insert
unless the need is clinically documented in
the chart and a DER is approved.
MEASURE: The dosage on package insert will
be compared to the dosage being
administered: If a change (increase or
decrease) in medication dosage is
demonstrated, an approved DER and/or
clinical rational document shall be in
inmate's medical record.
STANDARD: Achievement of outcome must meet
or exceed ninety-five percent (95%) on a
quarterly basis.
6) Logs
a) OUTCOME: All logs will be maintained
complete, current and with all information
required to document and track actions
taken.
MEASURE: Review of the logs and comparison
with OBIS and the medical records to
validate currency, accuracy and necessity of
information.
STANDARD: Achievement of outcome must meet
one hundred percent (100%) on a quarterly
basis.
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CONTRACT C2297
7) OBIS
a) OUTCOME: Required entries in OBIS are made
timely, completely and accurately.
MEASURE: OBIS entries shall be compared with
same entries in the medical record.
STANDARD: Achievement of outcome must meet
one hundred percent (100%) on a quarterly
basis.
8) Grievances
a) OUTCOME: Responses to grievances will be
made within required time frames and shall
be complete.
MEASURE: Date of grievance response shall be
compared to date required to be filed.
STANDARD: Achievement of outcome must meet
one hundred percent (100%) on a quarterly
basis.
b) OUTCOME: Upheld grievance appeals will not
exceed one and one/tenth percent (1.1%) of
grievances filed during month.
MEASURE: Review of monthly Department
Grievance report
STANDARD: Achievement of outcome must meet
one hundred percent (100%) on a quarterly
basis.
9) No Shows
a) OUTCOME: 100% of "no shows" will be
followed-up as required by the appropriate
Health Services' Technical Instruction.
MEASURE: Review of documentation in logs,
Medical Record, MARS, Pharmacy Records and
Inmate Refusals.
CRITICAL STANDARD: Achievement of outcome
must meet one hundred percent (100%) on a
quarterly basis
b. Mental Health Services
1) Special House (Close Management)
a) OUTCOME: Inmates who are placed in
confinement status shall receive an initial
mental health interview within 5 days or
less for S-3's and within 30 days or less
for S-2's.
MEASURE: Date of placement in confinement
status compared to date of initial
interview.
CRITICAL STANDARD: Achievement of outcome
must meet or exceed ninety-five percent
(95%) on a quarterly basis.
b) OUTCOME: Mental Health Staff shall perform
rounds for inmates in confinement status not
less than once a week.
MEASURE: Date mental health staff conducts
rounds must fall at least once every seven
days.
CRITICAL STANDARD: Achievement of outcome
must meet or exceed ninety-five percent
(95%) on a quarterly basis.
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CONTRACT C2297
c) OUTCOME: Mental Health staff shall complete
a Behavioral Risk Assessment (BRA) on each
Close Management (CM) inmate within 14 days
of CM placement; within 120 days of the
initial assessment, every 180 days
thereafter; and within three (3) workdays of
a critical event.
MEASURE: The date of placement in CM or the
date of critical event compared to date of
BRA completion.
CRITICAL STANDARD: Achievement of outcome
must meet or exceed ninety-five percent
(95%) on a quarterly basis.
2) Suicide Prevention
a) OUTCOME: Reduce the rate per 100,000 of
inmate deaths by suicide for inmates
receiving mental healthcare.
MEASURE: The rate per 100,000 of inmate
deaths by suicide during each fiscal year.
STANDARD: Suicide deaths for inmates during
first year of the Contract must be equal to
or less than five (5) per 100,000 inmate
deaths by suicide. (Thereafter, the rate of
inmate deaths determined to be the result of
suicide shall not exceed the annual rate of
the previous FY.)
b) OUTCOME: Inmates shall receive follow-up
evaluation of mental health status and
institutional adjustment on the 7th day and
on the 21st day following release from the
Infirmary Management Room (IMR) to General
Population.
MEASURE: Date of discharge from IMR compared
to date follow-up evaluations were
completed.
CRITICAL STANDARD: Achievement of outcome
must meet or exceed ninety-five (95%) on a
quarterly basis.
3) Infirmary and Inpatient Mental Health
a) OUTCOME: Reduce the Average Length of Stay
(ALOS) per inmate within the CSU setting to
equal to or less than the Department's ALOS
of 1.5 per day per inmate (excluding inmates
awaiting judicial proceeding for involuntary
commitment to a CMHI unit)
MEASURE: The ALOS per day per inmate in the
CSU setting on a fiscal year basis.
CRITICAL STANDARD: Achievement of outcome
must meet or exceed ninety-five (95%) on a
quarterly basis.
b) OUTCOME: Inmates admitted to the IMR for
mental health reasons shall receive mental
health care daily following admission
(except weekends/holidays).
MEASURE: The date of admission to IMR
compared to dates of daily rounds by
attending physician in the infirmary record.
CRITICAL STANDARD: Achievement of outcome
must meet or exceed ninety-five (95%) on a
quarterly basis.
C) OUTCOME: Inmate shall receive mental health
care within 72 hours following admission to
a Transitional Care Unit (TCU).
MEASURE: The date of admission to TCU
compared to date of initial appointment with
case manager.
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STANDARD: Achievement of outcome must meet
or exceed ninety-five percent (95%) on a
quarterly basis.
d) OUTCOME: Inmates who evidence an impairment
that is primarily associated with an Axis I
diagnosis and are in need of care that
cannot be provided at the referring
institution, or another CSU shall have a
court-ordered petition initiated for
commitment to a CMHI Unit.
MEASURE: The number of inmates deemed to be
in need of involuntary treatment by a
licensed psychiatrist within the Department
for whom a petition has not been initiated.
CRITICAL STANDARD: Achievement of outcome
must meet or exceed ninety-five percent
(95%) on a quarterly basis.
4) Reception Centers
a) OUTCOME: All newly committed inmates,
including recidivists, shall receive a
comprehensive mental health screening within
14 calendar days of arrival at the Reception
Center.
MEASURE: The length of time between arrival
at Reception Center and receipt of mental
health screening.
CRITICAL STANDARD: Achievement of outcome
must meet or exceed ninety-five percent
(95%) on a quarterly basis.
b) OUTCOME: All newly committed inmates who
meet the diagnostic criteria for mental
retardation (i.e., IQ <70, impaired adaptive
behavior [Adaptive Behavior Checklist <35]
and onset before age 18) shall be assigned
an S grade of 2 and designated as impaired.
MEASURE: Review of each inmate's record for
score on the Adaptive Behavior Checklist,
and if criteria is met, verification of
assignment of S grade of 2 and designation
of impairment.
STANDARD: Achievement of outcome must meet
one-hundred percent (100%) on a quarterly
basis.
5) Sex Offender Screenings
a) OUTCOME: Inmates who are serving a sentence
for a sex offense shall be screened within
thirty (30) days of arrival at first
permanent institution to identify those who
suffer from a sexual disorder and are
amenable to treatment.
MEASURE: The date of Sex Offender Screening.
STANDARD: Achievement of outcome must meet
or exceed ninety-five percent (95%) on a
quarterly basis.
6) Informed Consent
a) OUTCOME: Prior to receiving medication for a
psychiatric disorder(s), each inmate shall
give informed consent by signing the
appropriate release form, which shall be
placed in the inmate's health records.
MEASURE: The presence or absence of Informed
Consent Form in the inmate's medical record.
CRITICAL STANDARD: Achievement of outcome
must meet one-hundred percent (100%) on a
quarterly basis.
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7) Psychiatric Restraints
a) OUTCOME: Application of restraints pursuant
to initial order shall not exceed 4 hours.
MEASURE: The length of time inmate is
restrained.
CRITICAL STANDARD: Achievement of outcome
must meet or exceed ninety-five percent
(95%) on a quarterly basis.
8) Aftercare
a) OUTCOME: An aftercare plan shall be
completed for continuity of care after
expiration of sentence (EOS) for all inmates
with a diagnosis of mental retardation or
psychological grades of S-3 through S-6 no
later than 180 days prior to EOS.
MEASURE: The date that continuity of care
planning was initiated and was added to the
Individualized Service Plan compared to date
of completion of the aftercare plan.
CRITICAL STANDARD: Achievement of outcome
must meet or exceed ninety-five percent
(95%) on a quarterly basis.
9) Outpatient Mental Health
a) OUTCOME: All inmates, regardless of assigned
S grade, shall be oriented to mental health
services within eight (8) calendar days of
arrival.
MEASURE: The date of written and verbal
orientation to mental health services
compared to date of arrival at new
institution.
STANDARD: Achievement of outcome must meet
or exceed ninety-five percent (95%) on a
quarterly basis.
b) OUTCOME: A case manager shall be assigned
(by the psychology supervisor) to all S-2
and S-3 inmates within 72 hours of arrival
at the new institution.
MEASURE: Date of case manager assignment
compared to date of arrival at new
institution.
STANDARD: Achievement of outcome must meet
or exceed ninety-five percent (95%) on a
quarterly basis.
c) OUTCOME: A psychiatric update shall be
completed for each newly arriving S-3 inmate
by a psychiatrist or psychiatric ARNP within
ten (10) calendar days of arrival at new
institution.
MEASURE: Date of psychiatric update compared
to date of arrival at new institution.
CRITICAL STANDARD: Achievement of outcome
must meet one-hundred percent (100%) on a
quarterly basis.
10) Practitioner's Prescribing Practices
a) OUTCOME: All prescriptions will be written
in compliance with the Department's drug
formulary or will be accompanied by an
appropriate DER form.
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MEASURE: Review of prescriptions to
determine whether written only for
medications on the Department's drug
formulary or pursuant to an approved Drug
Exception Request (DER) that is in the
inmate's record.
STANDARD: Achievement of outcome must be one
hundred percent (100%) on a quarterly basis.
b) OUTCOME: All medications will be prescribed
in therapeutic dosage ranges as determined
by the most current editions of Drug Facts
and Comparisons, Physicians' Desk Reference,
or the package insert.
MEASURE: Review of prescriptions for
compliance with therapeutic ranges or if not
within ranges, an approved DER and/or
clinical rational document shall be in
inmate's medical record.
CRITICAL STANDARD: Achievement of outcome
must meet or exceed ninety-five percent
(95%) on a quarterly basis.
c) OUTCOME: Dosages of medication will not be
changed, increased or decreased contrary to
time frames stated in the package insert
unless the need is clinically documented in
the chart and a DER is approved.
MEASURE: The dosage on package insert will
be compared to the dosage being
administered: If a change (increase or
decrease) in medication dosage is
demonstrated, an approved DER and/or
clinical documentation shall be in inmate's
medical record.
STANDARD: Achievement of outcome must meet
or exceed ninety-five percent (95%) on a
quarterly basis.
c. Dental Services
1) Oral Surgery (Except for reception centers)
a) OUTCOME: Oral surgery shall not exceed
eleven percent (11%) of the overall dental
productivity for each institution.
MEASURE: Amount of Oral Surgery procedures
provided as a percentage of overall
dentistry.
STANDARD: Achievement of outcome must meet
or exceed ninety-five percent (95%) on a
quarterly basis.
2) Restorative Dentistry (Except for reception
centers)
a) OUTCOME: Restorative Dentistry shall be
equal to or more than sixteen percent (16%)
of the overall dental productivity for each
institution.
MEASURE: Amount of Restorative Dentistry
procedures provided as a percentage of
overall dentistry.
STANDARD: Achievement of outcome must meet
or exceed ninety-five percent (95%) on a
quarterly basis.
3) Wait for Routine Dental Care
a) OUTCOME: Initial wait after request for
routine dental care shall not exceed eight
(8) months for any inmate.
MEASURE: The amount of time between request
for routine dental care and delivery of
routine dental care for all inmates during
the quarter.
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CRITICAL STANDARD: Achievement of outcome
must meet or exceed ninety-five percent
(95%) on a quarterly basis.
4) Wait time between Dental Appointments between
First Appointment and Follow-Up Appointment
a) OUTCOME: Inmate waiting time between dental
appointments shall not exceed four (4)
months.
MEASURE: The amount of time between initial
appointment and follow-up for all inmates
receiving dental care during the quarter.
CRITICAL STANDARD: Achievement of outcome
must meet or exceed ninety-five percent
(95%) on a quarterly basis.
5) Practitioners' Prescribing Practices
a) OUTCOME: All prescriptions will be written
in compliance with the Department's drug
formulary or will be accompanied by an
appropriate DER form.
MEASURE: Review of prescriptions to
determine whether written only for
medications on the Department's drug
formulary or pursuant to an approved Drug
Exception Request (DER) that is in the
inmate's record.
STANDARD: Achievement of outcome must be one
hundred percent (100%) on a monthly basis.
d. Pharmacy Services
1) OUTCOME: All REGULAR PRESCRIPTION orders shall be
filled within twenty-four (24) hours or the next
day from time-of-order to time-of-receipt at
ordering Department Institution, excluding
holidays and weekends.
MEASURE: Date-of-order as compared to
date-of-receipt.
CRITICAL STANDARD: Achievement of outcome must be
ninety-eight percent (98%) or better on a
quarterly basis.
2) OUTCOME: All prescription orders shall be ONLY
filled in compliance with the Department's drug
formulary or pursuant to an approved Drug
Exception Request (DER).
MEASURE: Review of prescriptions to determine
whether filled only for medications on the
Department's drug formulary or pursuant to an
approved Drug Exception Request (DER) that is in
the inmate's record.
STANDARD: Achievement of outcome must be one
hundred percent (100%) on a quarterly basis.
3) OUTCOME: All medications will be filled in
therapeutic dosage ranges as determined by the
most current editions of Drug Facts and
Comparisons, Physicians' Desk Reference, or the
package insert or pursuant to an approved DER.
MEASURE: Review of prescriptions for compliance
with therapeutic ranges or if not within ranges,
approved DER shall be in inmate's medical record.
STANDARD: Achievement of outcome must meet or
exceed ninety-five percent (95%) on a quarterly
basis.
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4) OUTCOME: Dosages of medication, unless changed
(increased or decreased) contrary to time frames
stated in the package insert will not be filled
unless the need is clinically documented in the
chart and a DER is approved.
MEASURE: The dosage on package insert shall be
compared to the dosage being administered: If a
change (increase or decrease) in medication dosage
is demonstrated, an approved DER and/or clinical
rational document shall be in inmate's medical
record.
STANDARD: Achievement of outcome must be one
hundred percent (100%) on a quarterly basis.
THE CONTRACTOR SHALL ADVISE THE DEPARTMENT, IN WRITING, OF ANY
EXTENUATING CIRCUMSTANCES THAT WILL PROHIBIT THE CONTRACTOR
FROM MEETING THE ABOVE-OUTLINED PERFORMANCE OUTCOMES AND
STANDARDS.
2. Other Contract Requirements
STANDARD: The Department will monitor the Contractor's
performance to determine compliance with other contract
requirements at each institutional site, including, but not
limited to the following:
a. Compliance with Terms and Conditions of the Contract not
involving delivery of services otherwise listed above;
and
b. Invoicing and supporting documentation.
MEASURE: The Contractor shall achieve 100% compliance after
the time frames allowed for corrective action on identified
deficiencies. Performance shall be measured on a quarterly
basis beginning the ninety-first day after services have been
implemented at the institution, except if earlier action is
determined necessary by the Contract Manager.
EE. Monitoring Methodology
The Department's Contract Manager and assigned Contract Monitoring
Team will monitor the Contractor's service delivery AT EACH
INSTITUTIONAL SITE, to determine if the Contractor has achieved the
required level of performance for each Performance Outcome and
Standard identified in Section II., DD., 1., and for additional
Contract Requirements, including compliance with Contract terms and
conditions as established on the CONTRACT MONITORING INSTRUMENT
provided in sample form as EXHIBIT E. (Final Contract Monitoring
tool to be developed by the Department's Office of Health Services
in accordance with the requirements outlined in this Contract.)
PERFORMANCE SHALL BE MEASURED ON A QUARTERLY BASIS BEGINNING THE
NINETY-FIRST DAY AFTER SERVICES HAVE BEEN IMPLEMENTED. Such
monitoring may include, but is not limited to, both announced and
unannounced site visits.
The Department's Contract Monitoring Team will provide an oral exit
report at termination of the site visit and a written monitoring
report to the Contractor within three weeks of the visit.
Non-compliance issues identified by the Contract Manager and/or
Contract Monitoring Team will be identified in detail to provide
opportunity for correction, where feasible.
Within ten (10) days of receipt of the Department's monitoring
report, the Contractor shall provide a formal Corrective Action Plan
(CAP) in response to all noted deficiencies to include responsible
individuals and required time frames for achieving compliance. The
Contract Manager and Contract Monitoring Team or other designated
Department staff
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members may conduct follow-up monitoring reviews (including site
visits) at any time to determine compliance based upon the submitted
CAP.
During follow-up monitoring, any noted failure by the Contractor to
correct deficiencies identified in the monitoring report within the
time frame specified in the CAP may result in application of
Liquidated Damages as specified in Section II., FF. Repeated
instances of failure to meet contract compliance or to correct
deficiencies may result in imposition of liquidated damages,
determination of Breach of Contract, and/or termination of the
contract in accordance with Section VI., Termination.
FF. Liquidated Damages (General)
By executing this Contract, the Contractor expressly agrees to the
imposition of liquidated damages, in addition to all other remedies
available to the Department by law.
The Department's Contract Manager will provide written notice to the
Contractor's Representative of all liquidated damages assessed
accompanied by detail sufficient for justification of assessment.
The Contractor shall forward a cashier's check or money order to the
Contract Manager, payable to the Department in the appropriate
amount, within ten (10) days of receipt of a written notice of
demand for damages due, or in the alternative, the Contractor may
issue a credit in the amount of damages due on the next monthly
invoice or request the Department to apply the amount of damages due
against any monies owed the Contractor on the next monthly payment,
following assessment of damages. Documentation of the amount to be
imposed shall be included with the invoice if issuing credit.
Damages not paid within sixty (60) days of receipt of notice will be
deducted from amounts then due the Contractor.
1. Liquidated Damages For Failure to meet Performance Outcomes
and Standards:
The Contractor hereby acknowledges and agrees that its
performance under the Contract must meet the Performance
Outcomes and Standards set forth in Section II., DD., 1. If
the Contractor fails to meet these Performance Outcomes and
Standards, the Department will impose Liquidated Damages in
the amount of $2500.00 PER CRITICAL STANDARD, per
institutional site, and $1500.00 PER NON-CRITICAL STANDARD per
institutional site. Repeated failure to meet either critical
or non-critical standards in consecutive months will result in
liquidated damages being doubled for each institution failing
those standards. The Department may also choose to terminate
the contract in the absence of any extenuating or mitigating
circumstances. The determination of the existence of
extenuating or mitigating circumstances is within the
exclusive discretion of the Department. The Department, at its
exclusive option, may allow up to a three (3) month "grace
period" per institution following implementation of services
during which no damages will be imposed for failure to achieve
the standards. Monitoring will not usually commence until the
ninety-first (91st) day after Contractor assumes the provision
of care at an institution.
2. Liquidated Damages For Other Contract Requirements
For failure to meet other contract requirements, set forth in
subsection II., DD. 2., liquidated damages will be imposed,
per institutional site, as follows:
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a. Within the first fifteen (15) days after written notice
from the Contract Manager or Contract Monitoring Team of
deficiency - No imposition of damages if deficiency is
corrected within the time frame specified.
b. After fifteen (15) days of initial notice of
unsatisfactory service at an institution (without
corrective action initiated by the Contractor and if
unsatisfactory service continues) liquidated damages in
the amount of $1,000 per day for each day or part
thereof that the deficiency/issue remains uncorrected
shall be imposed.
c. Where the same instance of unsatisfactory service occurs
on three or more occasions within a ninety (90) day
period, (where the deficiencies have not been corrected
as indicated in (a) above), liquidated damages shall be
imposed in the amount of $2,000 per each thirty (30) day
period the deficiency remained uncorrected.
NOTE: THE DEPARTMENT HAS THE DISCRETION TO DETERMINE WHETHER
LIQUIDATED DAMAGES WILL BE IMPOSED FOR FAILURE TO MEET OTHER
CONTRACT REQUIREMENTS DURING THE INITIAL THREE (3) MONTHS OF
OPERATION AT AN INSTITUTIONAL SITE.
3. Liquidated Damages For Failure to Maintain ACA Accreditation
In order to maintain accreditation with the American
Correctional Association, each operational area within each
institution must be in compliance with ACA standards. Even
where only a single operational area within an institution is
found non-compliant with ACA standards, the entire institution
will lose its accreditation. Therefore, in the event an
institution fails to maintain ACA accreditation due to the
non-compliance of the healthcare delivery system, liquidated
damages in the amount of $50,000 will be assessed against the
Contractor. Full compliance with ACA Standards and
reobtainment of accreditation must be reestablished as soon
as possible. Liquidated damages shall be assessed per
institution and per incident of loss of accreditation.
GG. Deliverables
The following services or service tasks are identified as
deliverables for the purposes of this Contract:
1. Appropriate comprehensive health care services for inmates
consisting of:
a. Appropriate medical services for Department inmates in
Region IV on a daily basis.
b. Appropriate mental health services for Department
inmates in Region IV on a daily basis.
c. Appropriate dental services for Department inmates in
Region IV on a daily basis.
d. Appropriate pharmacy services for Department inmates in
Region IV on a daily basis.
2. Reports as required in Section II., AA., Reporting
Requirements.
3. Compliance with contract terms and conditions.
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III. COMPENSATION
A. Payment
This is a fixed price Contract based on a monthly capitation rate.
The Department will compensate the Contractor for the provision of
medical services as specified in the Scope of Service. Payment will
be made on a monthly basis at the capitation rate (unit price) per
inmate times the average monthly number of inmates. The average
monthly number of inmates will be determined by the Department's
official Monthly Average Daily Population (ADP) report which is
determined by taking the midnight counts on each day totaled for the
month and divided by the number of days in the month. Payment for
each facility shall begin at 12:01 a.m. on the implementation date
contingent upon actual implementation of healthcare service
delivery.
INITIAL TERM
CONTRACT YEAR YEAR 1 YEAR 2 YEAR 3 YEAR 4 YEAR 5
------------------ ------- ------- ------- ------- -------
SINGLE INMATE
PRICE PER MONTH
(MONTHLY
CAPITATION RATE -
UNIT PRICE) $337.41 $348.76 $359.22 $369.99 $381.09
OPTIONAL RENEWAL YEARS
CONTRACT YEAR YEAR 6 YEAR 7 YEAR 8 YEAR 9 YEAR 10
-------------------- ------- ------- ------- ------- -------
SINGLE INMATE
PRICE
PER MONTH (MONTHLY
CAPITATION RATE -
UNIT PRICE) $392.53 $404.30 $416.43 $428.92 $441.79
Monthly adjustments will also be made for costs defined as payable
by the Contractor which have been paid by the Department or costs
defined as payable by the Department which have been paid by the
Contractor. Such adjustments will be added or deducted to the
subsequent monthly payment after reconciliation between the
Department and the Contractor. The monthly payment may also be
adjusted based upon imposition of liquidated damages.
The last payment of the Contract will be withheld until all pending
adjustments including those provided for in Section II., CC., of
this Contract, have been determined and reconciled.
B. MyFloridaMarketPlace Transaction Fee Exemption
The State of Florida has instituted MyFloridaMarketPlace, a
statewide eProcurement System ("System"). Pursuant to section
287.057(23), Florida Statutes, all payments shall be assessed a
Transaction Fee of one percent (1.0%), which the Contractor shall
pay to the State, unless exempt pursuant to 60A-1.032, F.A.C.
The Department has determined that payments to be made under this
Contract are not subject to the MyFloridaMarketPlace Transaction Fee
pursuant to Rule 60A-1. 032,(l)(i),
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Florida Administrative Code (F.A.C). Form PUR 3777, Notice of
Transaction Fee Exemption, has been filed by the Department.
C. Submission of Invoice(s)
The Contractor agrees to request compensation on a monthly basis
through submission to the Department of a single monthly invoice,
properly completed and submitted electronically, within fifteen (15)
days following the end of the month for which payment is being
requested. The invoice shall be accompanied by all required Invoice
Supporting Documentation. Any adjustments to the invoice must be
fully explained with documentation.
The Contractor shall submit invoices pertaining to this Contract to:
Xxxxx X. Xxxxxxxx
Office of Health Services
Florida Department of Corrections
0000 Xxxxx Xxxxx Xxxx
Xxxxxxxxxxx, Xxxxxxx 00000-0000
Telephone: (000) 000-0000
Fax: (000) 000-0000
D. Supporting Documentation for Invoice(s)
Invoices must be submitted in detail sufficient for a proper
pre-audit and post-audit thereof. INVOICES WILL ONLY BE APPROVED
AFTER RECEIPT OF THE REQUIRED INVOICE SUPPORTING DOCUMENTATION
AS DESCRIBED IN SECTION II., AA.
Services will be considered complete and certified as payable when
all required monthly reports for the previous month have been
received. The required monthly reports are those described in
Section II., AA., 3., a.-d. In the event one or more institutions'
reports are not received, payment for the average daily population
(ADP) of those institutions will be withheld until the reports are
received.
E. Electronic Transfer of Funds
If requested, the Department may expedite payment of all Contractor
invoices and make payment to the Contractor electronically, in
accordance with Chapter 215, Florida Statutes. In order to receive
Electronic Funds Transfers for payments of work performed under this
Contract, the Contractor must contact the Florida Department of
Financial Services, Bureau of Accounting, EFT Section. The current
contacts for the EFT Section at the Department of Financial Services
are Xxxx Xxxxxxxx at (000) 000-0000 or Xxxxx Xxxxx at (850)
410-9372.
F. Official Payee
The name and address of the official payee to whom payment shall be
made is as follows:
Prison Health Services, Inc.
000 Xxxxxxxx Xxxxx, Xxxxx 000
Xxxxxxxxx, Xxxxxxxxx 00000
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G. Travel Expenses
The Department shall not be responsible for the payment of any
travel expense for the Contractor which occurs as a result of this
Contract.
H. Contractor's Expenses
The Contractor shall pay for all licenses, permits, and inspection
fees or similar charges required for this Contract, and shall comply
with all laws, ordinances, regulations, and any other requirements
applicable to the work to be performed under this Contract.
I. Annual Appropriation
The State of Florida's and the Department's performances and
obligations to pay for services under this Contract are contingent
upon an annual appropriation by the Legislature. The costs of
services paid under any other Contract or from any other source are
not eligible for reimbursement under this Contract.
J. Tax Exemption
The Department agrees to pay for contracted services according to
the conditions of this Contract. The State of Florida does not pay
federal excise taxes and sales tax on direct purchases of services.
K. Timeframes for Payment and Interest Penalties
Contractors providing goods and services to the Department should be
aware of the following time frames:
1. Upon receipt, the Department has five (5) working days to
inspect and approve the goods and services and associated
invoice, unless the ITB or RFP specifications, or this
Contract specifies otherwise. The Department has twenty (20)
days to deliver a request for payment (voucher) to the
Department of Financial Services. The twenty (20) days are
measured from the latter of the date the invoice is received
or the goods or services are received, inspected, and
approved.
2. If a payment is not available within forty (40) days, a
separate interest penalty, as specified in Section 215.422,
Florida Statutes, will be due and payable, in addition to the
invoice amount, to the Contractor. The interest penalty
provision applies after a thirty-five (35) day time period to
health care contractors, as defined by rule. Interest
penalties of less than one (1) dollar will not be enforced
unless the Contractor requests payment. Invoices, which have
to be returned to a Contractor because of Contractor
preparation errors, may cause a delay of the payment. The
invoice payment requirements do not start until the Department
receives a properly completed invoice.
L. Final Invoice
The Contractor shall submit the final invoice for payment to the
Department no more than forty-five (45) days after acceptance of the
final deliverable or the end date of the Contract, by the
Department. If the Contractor fails to do so, all right to payment
is forfeited, and the Department will not honor any request
submitted after aforesaid time period. Any payment
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due under the terms of this Contract may be withheld until all
applicable deliverables and invoices have been accepted and approved
by the Contract Manager.
M. Vendor Ombudsman
A Vendor Ombudsman has been established within the Department of
Financial Services. The duties of this individual include acting as
an advocate for vendors who may be experiencing problems in
obtaining timely payment(s) from a state agency. The Vendor
Ombudsman may be contacted by calling the Department of Financial
Services' Toll Free Hotline.
IV. CONTRACT MANAGEMENT
The Department has assigned the following named individuals, address and
phone number as indicated, as Contract Manager and Contract Administrator
for this Contract.
A. Department's Contract Manager
The Contract Manager for this Contract will be:
Xxxxx X. Xxxxxxxx
Office of Health Services
Florida Department of Corrections
0000 Xxxxx Xxxxx Xxxx
Xxxxxxxxxxx, Xxxxxxx 00000-0000
Telephone: (000) 000-0000
Fax: (000) 000-0000
Email: xxxxxxxx.xxxxx@xxxx.xx.xxxxx.xx.xx
The Contract Manager or his designee will perform all Department
designated monitoring tasks designated in the Scope of Service as
well as the following functions:
1. Serve as the liaison between the Department and the
Contractor;
2. Verify receipt of deliverables from the Contractor;
3. Monitor the Contractor's progress;
4. Evaluate the Contractor's performance;
5. Direct the Contract Administrator to process all amendments,
renewals and terminations of this Contract;
6. Review, verify, and approve invoices from the Contractor; and
7. Evaluate Contractor performance upon completion of the overall
Contract. This evaluation will be placed on file and will be
considered if the Contract is subsequently used as a reference
in future procurements.
B. Department's Contract Administrator
The Contract Administrator for this Contract will be:
Xxxx X. Xxxxxxx, Chief
Bureau of Procurement & Supply
Department of Corrections
0000 Xxxxx Xxxxx Xxxx
Xxxxxxxxxxx, Xxxxxxx 00000-0000
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Telephone: (000) 000-0000
Fax: (000) 000-0000
Email: xxxxxxx.xxxx@xxxx.xx.xxxxx.xx.xx
The Contract Administrator will perform the following functions:
1. Maintain the official Contract file;
2. Process all Contract amendments, renewals, and termination of
the Contract; and
3. Maintain the official records of all formal correspondence
between the Department and the Contractor.
C. Contractor's Representative
The name, title, address, and telephone number of the Contractor's
representative responsible for administration and performance under
this Contract is:
Xxx Xxxxxxxx, Group Vice President
Prison Health Services, Inc.
000 Xxxxxxxx Xxxxx, Xxxxx 000
Xxxxxxxxx, Xxxxxxxxx 00000
Telephone: (000) 000-0000
Fax: (000) 000-0000
Email: Xxxxxxxx@xxxx.xxx
D. Contract Management Changes
After execution of this Contract, any changes in the information
contained in Section IV., Contract Management, will be provided to
the other party in writing and a copy of the written notification
shall be maintained in the official Contract record.
V. CONTRACT MODIFICATION
Modifications to the provisions of this Contract, with the exception of
Subsection IV., Contract Management, shall be effected only through
execution of a formal Contract amendment, signed by both parties unless
otherwise authorized by this Contract.
A. Department Required Scope Changes
During the term of the Contract, the Department may unilaterally
require, by written notice, changes altering, adding to, or
deducting from the Contract specifications, provided that such
changes are within the general scope of the Contract. The Department
may make an equitable adjustment, (i.e. increase or decrease in
rate, reimbursement for costs, etc.) if the change affects the cost
or service delivery. The Contractor will be required to
expeditiously execute an amendment to effect such changes, which
execution shall not be unreasonably withheld. The Department shall
endeavor to provide written notice to the Contractor thirty (30)
days in advance of any Department-required changes to the technical
specifications and/or scope of service that affect the Contractor's
ability to provide the services as specified herein.
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B. Other Requested Changes
In addition to changes pursuant to Section V., A., State or Federal
laws, rules and regulations or Department, rules and regulations may
change. Such changes may impact Contractor's service delivery in
terms of materially increasing or decreasing the Contractor's cost
of providing services. There is no way to anticipate what those
changes will be nor is there any way to anticipate the costs
associated with such changes.
Either party shall have ninety (90) days from the date such change
is implemented to request an increase or decrease in compensation or
the applicant party will be considered to have waived this right.
Full, written justification with documentation sufficient for audit
will be required to authorize an increase in compensation. It is
specifically agreed that any changes to payment will be effective
the date the changed scope of services is approved, in writing, and
implemented. The parties agree to work in good faith and in an
expeditious manner to negotiate and agree in writing to such an
equitable adjustment to payment.
If the parties are unable to negotiate an agreed-upon increase or
decrease in rate or reimbursement, the Assistant Director of Health
Services, Administration shall determine based upon the changes made
to the scope of services, what the resultant change in compensation
should be.
VI. TERMINATION
A. Termination at Will
This Contract may be terminated by either party upon no less than
ninety (90) calendar days' notice, without cause, unless a lesser
time is mutually agreed upon by both parties. Notice shall be
delivered by certified mail (return receipt requested), by other
method of delivery whereby an original signature is obtained, or
in-person with proof of delivery.
B. Termination Because of Lack of Funds
In the event funds to finance this Contract become unavailable, the
Department may terminate the Contract upon no less than twenty-four
(24) hours' notice in writing to the Contractor. Notice shall be
delivered by certified mail (return receipt requested), facsimile,
by other method of delivery whereby an original signature is
obtained, or in-person with proof of delivery. The Department shall
be the final authority as to the availability of funds.
C. Termination for Cause
If a breach of this Contract occurs by the Contractor, the
Department may, by written notice to the Contractor, terminate this
Contract upon twenty-four (24) hours' notice. Notice shall be
delivered by certified mail (return receipt requested), by other
method of delivery whereby an original signature is obtained, or
in-person with proof of delivery. If applicable, the Department may
employ the default provisions in Chapter 60A-1, Florida
Administrative Code. The provisions herein do not limit the
Department's right to remedies at law or to damages.
D. Termination for Unauthorized Employment
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Violation of the provisions of Section 274A of the Immigration and
Nationality Act shall be grounds for unilateral cancellation of this
Contract.
VII. CONDITIONS
A. Records
1. Public Records Law
The Contractor agrees to allow the Department and the public
access to any documents, papers, letters, or other materials
subject to the provisions of Chapters 119 and 945.10, Florida
Statutes, made or received by the Contractor in conjunction
with this Contract. The Contractor's refusal to comply with
this provision shall constitute sufficient cause for
termination of this Contract.
2. Audit Records
a. The Contractor agrees to maintain books, records, and
documents (including electronic storage media) in
accordance with generally accepted accounting procedures
and practices which sufficiently and properly reflect
all revenues and expenditures of funds provided by the
Department under this Contract, and agrees to provide a
financial and compliance audit to the Department or to
the Office of the Auditor General and to ensure that all
related party transactions are disclosed to the auditor.
b. The Contractor agrees to include all record-keeping
requirements in all subcontracts and assignments related
to this Contract.
c. The Contractor shall ensure that a financial and
compliance audit is conducted in accordance with the
applicable financial and compliance audit requirements
as specified in this Contract and Attachment #2, which
is incorporated herein as if fully stated.
3. Retention of Records
The Contractor agrees to retain financial records, supporting
documents, statistical records, and any other documents
(including electronic storage media) pertaining to this
Contract, with the exception of inmate healthcare records, for
a period of seven (7) years. (Healthcare records will remain
the property of the Department). The Contractor shall maintain
complete and accurate record- keeping and documentation as
required by the Department and the terms of this Contract.
Copies of all records and documents shall be made available
for the Department upon request. All invoices and
documentation must be clear and legible for audit purposes.
For the duration of this Contract, all documents must be
retained by the Contractor within the State of Florida, at an
address to be provided in writing to the Contract Manager
within thirty (30) days of the contract execution. Any records
not available at the time of an audit will be deemed
unavailable for audit purposes. Violations will be noted and
forwarded to the Department's Inspector General for review.
All documents must be retained by the Contractor at the
Contractor's primary place of business for a period of seven
(7) years following termination of this Contract, or, if an
audit has been initiated and audit findings have not been
resolved at the end of seven (7) years, the records shall be
retained until resolution of the audit findings. The
Contractor shall cooperate with the Department to facilitate
the duplication and transfer of any said records or documents
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during the required retention period. The Contractor shall
advise the Department of the location of all records
pertaining to this Contract and shall notify the Department by
certified mail within ten (10) days if/when the records are
moved to a new location.
B. State Objectives
Within thirty (30) calendar days following award of this Contract,
the Contractor shall submit plans addressing each of the State's
four (4) objectives listed below, to the extent applicable to the
items/services covered by this solicitation.
(Note: One Florida Initiative plans and reporting shall be submitted
to Xxxx Xxxxxxx, MBE Coordinator, Bureau of Procurement and Supply,
Department of Corrections, 0000 Xxxxx Xxxxx Xxxx, Xxxxxxxxxxx, XX
00000-0000. All other plans shall be submitted to the Contract
Manager or designee as specified in this contract.)
1. One Florida Initiative
Florida is a state rich in its diversity. Governor-Xxxx'x One
Florida Initiative is dedicated to fostering the continued
development and economic growth of small and minority and
women-owned businesses. Central to this initiative is the
participation of a diverse group of vendors doing business
with the state.
To this end, it is vital that minority and women-owned
business enterprises participate in the State's procurement
process as both prime contractors and subcontractors under
prime contracts. Small and minority and women-owned businesses
are strongly encouraged to participate.
To track the success of the One Florida Initiative, which has
achieved substantial gains in extending opportunity to
minority- and women-owned businesses, the State of Florida
maintains data to establish benchmarks from which to measure
supplier diversity in State contracting. Vendors who contract
with the state are obligated to provide information related to
the use of minority- and women-owned businesses and
subcontractors.
The Contractor shall submit documentation addressing the
Governor's One Florida Initiative and describing the efforts
being made to encourage the participation of small and
minority and women-owned businesses. Please refer to the
Governor's "Equity in Contracting Plan" when preparing this
documentation:
xxxx://xxx.xxxxxxxxxx.xxx/xxxxxxxxx/xxxxxxxxxx/
governorinitiatives/one_florida/equity_contracting.html
Equity in Contracting documentation should identify any
participation by diverse contractors and suppliers as prime
contractors, sub-contractors, vendors, resellers,
distributors, or such other participation as the parties may
agree. Equity in Contracting documentation shall include the
timely reporting of spending with certified and other minority
business enterprises. Such reports must be submitted at least
monthly and include the period covered, the name, minority
code and Federal Employer Identification Number of each
minority vendor utilized during the period, commodities and
services provided by the minority business enterprise, and the
amount paid to each minority vendor on behalf of each
purchasing agency ordering under the terms of this contract.
2. Environmental Considerations
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The State supports and encourages initiatives to protect and
preserve our environment. If applicable, the Contractor shall
submit a plan to support the procurement of products and
materials with recycled content, and the intent of Section
287.045, Florida Statutes. The Contractor shall also provide a
plan for reducing and or handling of any hazardous waste
generated by Contractor's company. Reference Rule 62-730.160,
Florida Administrative Code. It is a requirement of the
Florida Department of Environmental Protection that a
generator of hazardous waste materials that exceeds a certain
threshold must have a valid and current Hazardous Waste
Generator Identification Number. This identification number
shall be submitted as part of Contractor's explanation of its
company's hazardous waste plan and shall explain in detail its
handling and disposal of this waste.
3. Products Available from the Blind or Other Handicapped
(RESPECT)
The State/Department supports and encourages the gainful
employment of citizens with disabilities. It is expressly
understood and agreed that any articles that are the subject
of, or required to carry out, this Contract shall be purchased
from a nonprofit agency for the blind or for the severely
handicapped that is qualified pursuant to Chapter 413, Florida
Statutes, in the same manner and under the same procedures set
forth in Section 413.036(1) and (2), Florida Statutes; and for
purposes of this contract the person, firm, or other business
entity carrying out the provisions of this contract shall be
deemed to be substituted for this agency insofar as dealings
with such qualified nonprofit agency are concerned."
Additional information about the designated nonprofit agency
and the products it offers is available at
xxxx://xxx.xxxxxxxxxxxxxxxx.xxx.
If applicable, the Contractor shall submit a plan describing
how it will address the use of RESPECT.
4. Prison Rehabilitative Industries and Diversified Enterprises,
Inc. (PRIDE)
The State supports and encourages the use of Florida
correctional work programs. It is expressly understood and
agreed that any articles which are the subject of, or required
to carry out, this contract shall be purchased from the
corporation identified under Chapter 946, F.S., in the same
manner and under the same procedures set forth in Section
946.515(2), and (4), F.S.; and for purposes of this contract
the person, firm, or other business entity carrying out the
provisions of this contract shall be deemed to be substituted
for this agency insofar as dealings with such corporation are
concerned. Additional information about PRIDE and the products
it offers is available at xxxx://xxx.xxxxxxx.xxx.
If applicable, the Contractor shall submit a plan describing
how it will address the use of PRIDE.
C. Sponsorship
If the Contractor is a nongovernmental organization which sponsors a
program financed partially by State funds, including any funds
obtained through this Contract, it shall, in publicizing,
advertising, or describing the sponsorship of the program, state:
"Sponsored by Prison Health Services, Inc. and the State of Florida,
Department of Corrections." If the sponsorship reference is in
written material, the words "State of Florida, Department of
Corrections" shall appear in the same size letters or type as the
name of the organization.
D. Employment of Department Personnel
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The Contractor shall not knowingly engage in this project, on a
full-time, part- time, or other basis during the period of this
Contract, any current or former employee of the Department where
such employment conflicts with Section 112.3185, Florida Statutes.
E. Non-Discrimination
No person, on the grounds of race, creed, color, national origin,
age, gender, marital status or disability, shall be excluded from
participation in, be denied the proceeds or benefits of, or be
otherwise subjected to, discrimination in the performance of this
Contract.
F. Americans with Disabilities Act
The Contractor shall comply with the Americans with Disabilities
Act. In the event of the Contractor's noncompliance with the
nondiscrimination clauses, the Americans with Disabilities Act, or
with any other such rules, regulations, or orders, this Contract may
be canceled, terminated, or suspended in whole or in part and the
Contractor may be declared ineligible for further Contracts.
G. Indemnification for Contractors Acting as an Agent of the State
The Contractor shall be liable, and agrees to be liable for, and
shall indemnify, defend, and hold the Department, its employees,
agents, officers, heirs, and assignees harmless from any and all
claims, suits, judgments, or damages including court costs and
attorney's fees arising out of intentional acts, negligence, or
omissions by the Contractor, or its employees or agents, in the
course of the operations of this Contract, including any claims or
actions brought under Title 42 USC Section 1983, the Civil Rights
Act, up to the limits of liability set forth in Section 768.28,
Florida Statutes.
H. Contractor's Insurance for Contractors Acting as an Agent of the
State
The Contractor warrants that it is and shall remain for the term of
this Contract, in compliance with the financial responsibility
requirements of Section 458.320, Florida Statutes, and is not
entitled to, and shall not claim, any exemption from such
requirements. The Contractor also warrants that funds held under
Section 458.320, Florida Statutes, are available to pay claims
against the State in accordance with Section VII., G.,
Indemnification for Contractors Acting as an Agent of the State.
The Contractor agrees to provide adequate liability insurance
coverage to the extent of liability under Section 768.28, Florida
Statutes, on a comprehensive basis and to hold such liability
insurance at all times during the existence of this Contract. Upon
the execution of this Contract, the Contractor shall furnish the
Contract Manager written verification supporting such insurance
coverage. Such coverage may be provided by a self-insurance program
established and operating under the laws of the State of Florida.
The Department reserves the right to require additional insurance
where appropriate.
If the Contractor is a state agency or subdivision as defined in
Section 768.28, Florida Statutes, the Contractor shall furnish the
Department, upon request, written verification of liability
protection in accordance with Section 768.28, Florida Statutes.
Nothing herein shall be construed to extend any party's liability
beyond that provided in Section 768.28, Florida Statutes.
I. Contractors Acting as an Agent of the State
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The parties specifically agree that the Contractor, its agents,
employees and subcontractors are agents of the State while they are
providing services under this Contract, and the relationship stated
in this paragraph is to avail the Contractor, its agents, employees
and subcontractors of the protections and immunities set forth in
Section 768.10, Florida Statutes. Accordingly, in the Contractor's
performance of its duties and responsibilities under this Contract,
the Contractor shall, at all times, act and perform as an agent of
the Department, but not as an employee of the Department. The
Department shall neither have nor exercise any control or direction
over the methods by which the Contractor shall perform its work and
functions other than as provided herein. Nothing in this Contract is
intended to, nor shall be deemed to constitute, a partnership or
joint venture between the parties.
J. Disputes
Any dispute concerning performance of this Contract shall be
resolved informally by the Contract Manager. Any dispute that can
not be resolved informally shall be reduced to writing and delivered
to the Department's Director of Health Services-Administration. The
Director of Health Services-Administration shall decide the dispute,
reduce the decision to writing, and deliver a copy to the
Contractor, the Contract Manager and the Contract Administrator.
K. Copyrights, Right to Data, Patents and Royalties
Where activities supported by this Contract produce original
writing, sound recordings, pictorial reproductions, drawings or
other graphic representation and works of any similar nature, the
Department has the right to use, duplicate and disclose such
materials in whole or in part, in any manner, for any purpose
whatsoever and to have others acting on behalf of the Department to
do so. If the materials so developed are subject to copyright,
trademark, or patent, legal title and every right, interest, claim
or demand of any kind in and to any patent, trademark or copyright,
or application for the same, will vest in the State of Florida,
Department of State for the exclusive use and benefit of the State.
Pursuant to Section 286.021, Florida Statutes, no person, firm or
corporation, including parties to this Contract, shall be entitled
to use the copyright, patent, or trademark without the prior written
consent of the Department of State.
The Department shall have unlimited rights to use, disclose or
duplicate, for any purpose whatsoever, all information and data
developed, derived, documented, or furnished by the Contractor under
this Contract. All computer programs and other documentation
produced as part of this Contract shall become the exclusive
property of the State of Florida, Department of State, with the
exception of data processing software developed by the Department
pursuant to Section 119.083, Florida Statutes, and may not be copied
or removed by any employee of the Contractor without express written
permission of the Department.
The Contractor, without exception, shall indemnify and save harmless
the Department and its employees from liability of any nature or
kind, including cost and expenses for or on account of any
copyrighted, patented, or unpatented invention, process, or article
manufactured or supplied by the Contractor. The Contractor has no
liability when such claim is solely and exclusively due to the
combination, operation, or use of any article supplied hereunder
with equipment or data not supplied by the Contractor or is based
solely and exclusively upon the Department's alteration of the
article. The Department will provide prompt written notification of
a claim of copyright or patent infringement and will afford the
Contractor full opportunity to defend the action and control the
defense of such claim.
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CONTRACT C2297
Further, if such a claim is made or is pending, the Contractor may,
at its option and expense, procure for the Department the right to
continue use of, replace, or modify the article to render it
noninfringing. (If none of the alternatives are reasonably
available, the Department agrees to return the article to the
Contractor upon its request and receive reimbursement, fees and
costs, if any, as may be determined by a court of competent
jurisdiction.) If the Contractor uses any design, device, or
materials covered by letter, patent or copyright, it is mutually
agreed and understood without exception that the Contract prices
shall include all royalties or costs arising from the use of such
design, device, or materials in any way involved in the work to be
performed hereunder.
L. Subcontracts
The Contractor is fully responsible for all work performed under
this Contract. The Contractor may, upon receiving written consent
from the Department's Contract Manager, enter into written
subcontract(s) for performance of certain of its functions under
this Contract. No subcontract, which the Contractor enters into with
respect to performance of any of its functions under this Contract,
shall in any way relieve the Contractor of any responsibility for
the performance of its duties. All payments to subcontractors shall
be made by the Contractor.
If a subcontractor is utilized by the Contractor, the Contractor
shall pay the subcontractor within seven (7) working days after
receipt of full or partial payments from the Department, in
accordance with Section 287.0585, Florida Statutes, unless the
contract between the Contractor and a Subcontractor provides
otherwise, as permitted by Section 287.0585(b), Florida Statues. It
is understood and agreed that the Department shall not be liable to
any subcontractor for any expenses or liabilities incurred under the
subcontract and that the Contractor shall be solely liable to the
subcontractor for all expenses and liabilities under this Contract.
Failure by the Contractor to pay the subcontractor within seven (7)
working days, or in accordance with the contract between the
Contractor and the Subcontractor, whichever is later, will result in
a penalty to be paid by the Contractor to the subcontractor in the
amount of one-half (1/2) of one percent (1%) of the amount due per
day from the expiration of the period allowed herein for payment.
Such penalty shall be in addition to actual payments owed and shall
not exceed fifteen percent (15%) of the outstanding balance due.
M. Assignment
The Contractor shall not assign its responsibilities or interests
under this Contract to another party without prior written approval
of the Department's Contract Manager. The Department shall, at all
times, be entitled to assign or transfer its rights, duties and
obligations under this Contract to another governmental agency of
the State of Florida upon giving written notice to the Contractor.
N. Force Majeure
Neither party shall be liable for loss or damage suffered as a
result of any delay or failure in performance under this Contract or
interruption of performance resulting directly or indirectly from
acts of God, accidents, fire, explosions, earthquakes, floods,
water, wind, lightning, civil or military authority, acts of public
enemy, war, riots, civil disturbances, insurrections, strikes, or
labor disputes.
O. Substitution of Key Personnel
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In the event the Contractor desires to substitute any key personnel,
either permanently or temporarily, the Department shall have the
right to approve or disapprove the desired personnel change in
advance in writing.
P. Severability
The invalidity or unenforceability of any particular provision of
this Contract shall not affect the other provisions hereof and this
Contract shall be construed in all respects as if such invalid or
unenforceable provision was omitted, so long as the material
purposes of this Contract can still be determined and effectuated.
Q. Use of Funds for Lobbying Prohibited
The Contractor agrees to comply with the provisions of Section
216.347, Florida Statutes, which prohibits the expenditure of State
funds for the purposes of lobbying the Legislature, the Judicial
branch, or a State agency.
R. Verbal Instructions
No negotiations, decisions, or actions shall be initiated or
executed by the Contractor as a result of any discussions with any
Department employee. Only those communications that are in writing
from the Department's staff identified in Section II., D.,
Communications and Section IV., Contract Management, of this
Contract shall be considered a duly authorized expression on behalf
of the Department. Only communications from the Contractor's
representative identified in Section IV., C., which are in writing
and signed, will be recognized by the Department as duly authorized
expressions on behalf of the Contractor.
S. Conflict of Interest
The Contractor shall not compensate in any manner, directly or
indirectly, any officer, agent or employee of the Department for any
act or service that he/she may do, or perform for, or on behalf of,
any officer, agent, or employee of the Contractor. No officer,
agent, or employee of the Department shall have any interest,
directly or indirectly, in any contract or purchase made, or
authorized to be made, by anyone for, or on behalf of, the
Department.
The Contractor shall have no interest and shall not acquire any
interest that shall conflict in any manner or degree with the
performance of the services required under this Contract.
T. State Licensing Requirements
All entities defined under Chapters 607, 617 or 620, Florida
Statutes, seeking to do business with the Department, shall be on
file and in good standing with the Florida Department of State.
U. MyFloridaMarketPlace Vendor Registration
All vendors that have not re-registered with the State of Florida
since March 31, 2003, shall go to
xxxx://xxxxxx.xxxxxxxxxxxxxxxxxxxx.xxx/ to complete on-line
registration, or call 0-000-000-0000 for assisted registration.
V. Public Entity Crimes Information Statement
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A person or affiliate who has been placed on the Convicted Vendor
List following a conviction for a public entity crime may not submit
a bid or proposal to provide any goods or services to a public
entity, may not submit a bid or proposal to a public entity for the
construction or repair of a public building or public work, may not
submit bids or proposals for leases of real property to a public
entity, may not be awarded or perform work as a Contractor,
supplier, subcontractor, or consultant under a Contract with any
public entity, and may not transact business with any public entity
in excess of the threshold amount provided in Section 287.017,
Florida Statutes, for Category Two for a period of thirty-six (36)
months from the date of being placed on the Convicted Vendor List.
W. Discriminatory Vendors List
An entity or affiliate who has been placed on the Discriminatory
Vendors List may not submit a bid or proposal to provide goods or
services to a public entity, may not be awarded a contract or
perform work as a Contractor, supplier, subcontractor or consultant
under contract with any public entity and may not transact business
with any public entity.
X. Governing Law and Venue
This Contract is executed and entered into in the State of Florida,
and shall be construed, performed and enforced in all respects in
accordance with the laws, rules and regulations of the State of
Florida. Any action hereon or in connection herewith shall be
brought in Xxxx County, Florida.
Y. No Third Party Beneficiaries
Except as otherwise expressly provided herein, neither this
Contract, nor any amendment, addendum or exhibit attached hereto,
nor term, provision or clause contained therein, shall be construed
as being for the benefit of, or providing a benefit to, any party
not a signatory hereto.
Z. Health Insurance Portability and Accountability Act
The Contractor shall comply with the Health Insurance Portability
and Accountability Act of 1996 (42 U. S. C. 1320d-8), and all
applicable regulations promulgated there under. Such compliance
shall be required by the execution of Attachment #1, Business
Associate Agreement for HIPAA, which is incorporated herein as if
fully stated.
AA. Reservation of Rights
The Department reserves the exclusive right to make certain
determinations regarding the service requirements outlined in the
Contract. The absence of the Department setting forth a specific
reservation of rights does not mean that any provision regarding the
services to be performed under this Contract are subject to mutual
agreement. The Department reserves the right to make any and all
determinations exclusively which it deems are necessary to protect
the best interests of the State of Florida and the health, safety
and welfare of the Department's inmates and of the general public
which is served by the Department, either directly or indirectly,
through these services.
BB. Cooperative Purchasing
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As provided in Section 287.042(16)(a), Florida Statutes, other State
agencies may purchase from this Contract, provided that the
Department of Management Services has determined that the Contract's
use is cost effective and in the best interest of the State. Upon
such approval, the Contractor may, at its discretion, sell these
commodities or services to additional agencies, upon the terms and
conditions contained herein. In addition, other political
subdivisions may also purchase from this Contract at the discretion
of the Contractor. Entities purchasing from this Contract assume and
bear complete responsibility with regard to performance of any
contractual obligation or term.
CC. Performance Guarantee
The Contractor shall furnish the Department with a Performance
Guarantee in the amount of one million dollars ($1,000,000.00) that
shall be in effect for a time frame equal to the term of the
contract. The form of the guarantee shall be a bond, cashier's
check, or money order made payable to the Department. The guarantee
shall be furnished to the Contract Manager within thirty (30) days
after execution of this Contract. No payments shall be made to the
Contractor until the guarantee is in place and approved by the
Department in writing. Upon renewal of this Contract, the Contractor
shall provide proof that the performance guarantee has been renewed
for the term of the Contract renewal.
Based upon Contractor performance after the initial year of the
Contract, the Department may, at the Department's sole discretion,
reduce the amount of the bond for any single year of the contract or
for the remaining contract period, including the renewal.
DD. Convicted Felons Certification
No personnel assigned to this Contract may be a convicted felon or
have relatives either confined by or under supervision of the
Department.
REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK
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CONTRACT C2297
Waiver of breach of any provision of this Contract shall not be deemed to be a
waiver of any other breach and shall not be construed to be a modification of
the terms of this Contract.
This Contract, and any attachments or exhibits if included, ITB# 05-DC-7666, and
the Contractor's response to the ITB, contain all the terms and conditions
agreed upon by the parties. In the event of any conflict in language among these
documents, this Department's contract document will govern.
IN WITNESS THEREOF, the parties hereto have caused this Contract to be executed
by their undersigned officials as duly authorized.
CONTRACTOR:
PRISON HEALTH SERVICES, INC.
SIGNED
BY: /s/ Xxxxxxx Xxxxxxxx APPROVED AS TO FORM
---------------------- by LEGAL DEPT.
NAME: Xxxxxxx Xxxxxxxx /s/ jsk 12-29-05
-------------------
TITLE: Chairman & President
DATE: 12-29-05
XXXX#: 00-0000000
DEPARTMENT OF CORRECTIONS
SIGNED SIGNED
BY: /s/ Xxxxx X. Xxxxxx, Xx. BY: /s/ Xxxxx X. Xxxxxx
------------------------- ---------------------
NAME: XXXXX X. XXXXXX, XX. NAME: XXXXX X. XXXXXX
TITLE: SECRETARY TITLE: GENERAL COUNSEL
DEPARTMENT OF CORRECTIONS DEPARTMENT OF CORRECTIONS
DATE: 12-30-05 DATE: 12-30-05
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CONTRACT C2297
ATTACHMENT #1
BUSINESS ASSOCIATE AGREEMENT
This Agreement supplements and is made a part of the contract between the
Florida Department of Corrections ("Department") and Prison Health Services,
Inc. ("Contractor"), (individually, a "Party" and collectively referred to as
"Parties").
Whereas, the Department creates or maintains, or has authorized the Contractor
to receive, create, or maintain certain Protected Health Information ("PHI,") as
that term is defined in 45 C.F.R. Section 164.501 and that is subject to
protection under the Health Insurance Portability and Accountability Act of
1996, as amended. ("HIPAA");
Whereas, the Department is a "Covered Entity" as that term is defined in the
HIPAA implementing regulations, 45 C.F.R. Part 160 and Part 164, Subparts A, C,
and E, the Standards for Privacy of Individually Identifiable Health Information
("Privacy Rule") and the Security Standards for the Protection of Electronic
Protected Health Information ("Security Rule");
Whereas, the Contractor may have access to Protected Health Information in
fulfilling its responsibilities under its contract with the Department;
Whereas, the Contractor is considered to be a "Business Associate" of Covered
Entity as defined in the Privacy Rule;
Whereas, pursuant to the Privacy Rule, all Business Associates of Covered
Entities must agree in writing to certain mandatory provisions regarding the use
and disclosure of PHI; and
Whereas, the purpose of this Agreement is to comply with the requirements of the
Privacy Rule, including, but not limited to, the Business Associate contract
requirements of 45 C.F.R. Section 164.504(e).
Now, therefore, in consideration of the mutual promises and covenants contained
herein, the Parties agree as follows:
1. DEFINITIONS
Unless otherwise provided in this Agreement, any and all capitalized terms
have the same meanings as set forth in the HIPAA Privacy Rule. Contractor
acknowledges and agrees that all Protected Health Information that is
created or received by the Department and disclosed or made available in
any form, including paper record, oral communication, audio recording, and
electronic display by the Department or its operating units to Contractor
or is created or received by Contractor on the Department's behalf shall
be subject to this Agreement.
2. CONFIDENTIALITY REQUIREMENTS
A. Contractor agrees to use and disclose Protected Health Information
that is disclosed to it by the Department solely for meeting its
obligations under its agreements with the Department, in accordance
with the terms of this agreement, the Department's established
policies rules, procedures and requirements, or as required by law,
rule or regulation.
B. In addition to any other uses and/or disclosures permitted or
authorized by this Agreement or required by law, Contractor may use
and disclose Protected Health Information as follows:
(1) if necessary for the proper management and administration of
the Contractor and to carry out the legal responsibilities of
the Contractor, provided that any such disclosure is required
by law or that Contractor obtains reasonable assurances from
the person to whom the information is disclosed that it will
be held confidentially and used or further disclosed only as
required by law or for the purpose for which it
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CONTRACT C2297
ATTACHMENT #1
was disclosed to the person, and the person notifies
Contractor of any instances of which it is aware in which the
confidentiality of the information has been breached;
(2) for data aggregation services, only if to be provided by
Contractor for the healthcare operations of the Department
pursuant to any and all agreements between the Parties. For
purposes of this Agreement, data aggregation services means
the combining of protected health information by Contractor
with the protected health information received by Contractor
in its capacity as a Contractor of another covered entity, to
permit data analyses that relate to the healthcare operations
of the respective covered entities.
C. Contractor will implement appropriate safeguards to prevent use or
disclosure of Protected Health Information other than as permitted
in this Agreement. Further, Contractor shall implement
administrative, physical, and technical safeguards that reasonably
and appropriately protect the confidentiality, integrity, and
availability of Electronic Protected Health Information that it
creates, receives, maintains, or transmits on behalf of the
Department. The Secretary of Health and Human Services and the
Department shall have the right to audit Contractor's records and
practices related to use and disclosure of Protected Health
Information to ensure the Department's compliance with the terms of
the HIPAA Privacy Rule. Contractor shall report to Department any
use or disclosure of Protected Health Information, which is not in
compliance with the terms of this Agreement as well as any Security
incident of which it becomes aware. Contractor agrees to notify the
Department, and include a copy of any complaint related to use,
disclosure, or requests of Protected Health Information that the
Contractor receives directly and use best efforts to assist the
Department in investigating and resolving such complaints. In
addition, Contractor agrees to mitigate, to the extent practicable,
any harmful effect that is known to Contractor of a use or
disclosure of Protected Health Information by Contractor in
violation of the requirements of this Agreement.
D. Contractor will ensure that its agents, including a subcontractor,
to whom it provides Protected Health Information received from, or
created by Contractor on behalf of the Department, agree to the same
restrictions and conditions that apply to Contractor, and apply
reasonable and appropriate safeguards to protect such information.
Contractor agrees to designate an appropriate individual (by title
or name) to ensure the obligations of this agreement are met and to
respond to issues and requests related to Protected Health
Information. In addition, Contractor agrees to take other reasonable
steps to ensure that its employees' actions or omissions do not
cause Contractor to breach the terms of this Agreement.
E. Contractor agrees to make available Protected Health Information so
that the Department may comply with individual rights to access in
accordance with Section 164.524 of the HIPAA Privacy Rule.
Contractor agrees to make Protected Health Information available for
amendment and incorporate any amendments to Protected Health
Information in accordance with the requirements of Section 164.526
of the HIPAA Privacy Rule. In addition, Contractor agrees to record
disclosures and such other information necessary, and make such
information available, for purposes of the Department providing an
accounting of disclosures, to the extent required by Section 164.528
of the HIPAA Privacy Rule.
F. The Contractor agrees, when requesting Protected Health Information
to fulfill its contractual obligations or on the Department's
behalf, and when using and disclosing Protected Health Information
as permitted in this contract, that the Contractor will request,
use, or disclose only the minimum necessary in order to accomplish
the intended purpose.
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ATTACHMENT #1
G. The Contractor agrees to defend and hold harmless the Department
against any action or liability or damages arising out of or related
to the Contractor's breach of its obligations under this agreement.
3. OBLIGATIONS OF DEPARTMENT
A. The Department will make available to the Business Associate the
notice of privacy practices (applicable to offenders under
supervision, not to inmates) that the Department produces in
accordance with 45 CFR 164.520, as well as any material changes to
such notice.
B. The Department shall provide Business Associate with any changes in,
or revocation of, permission by an Individual to use or disclose
Protected Health Information, if such changes affect Business
Associate's permitted or required uses and disclosures.
C. The Department shall notify Business Associate of any restriction to
the use or disclosure of Protected Health Information that impacts
the business associate's use or disclosure and that the Department
has agreed to in accordance with 45 CFR 164.522.
4. TERMINATION
A. Termination for Breach - The Department may terminate this Agreement
if the Department determines that Contractor has breached a material
term of this Agreement. Alternatively, the Department may choose to
provide Contractor with notice of the existence of an alleged
material breach and afford Contractor an opportunity to cure the
alleged material breach. In the event Contractor fails to cure the
breach to the satisfaction of the Department, the Department may
immediately thereafter terminate this Agreement.
B. Automatic Termination - This Agreement will automatically terminate
upon the termination or expiration of the original contract between
the Department and the Contractor.
C. Effect of Termination
(1) Termination of this agreement will result in termination of
the associated contract between the Department and the
Contractor.
(2) Upon termination of this Agreement or the contract, Contractor
will return or destroy all PHI received from the Department or
created or received by Contractor on behalf of the Department
that Contractor still maintains and retain no copies of such
PHI; provided that if such return or destruction is not
feasible, Contractor will extend the protections of this
Agreement to the PHI and limit further uses and disclosure to
those purposes that make the return or destruction of the
information infeasible.
5. AMENDMENT - Both parties agree to take such action as is necessary to
amend this Agreement from time to time as is necessary to comply with the
requirements of the Privacy Rule.
6. MISCELLANEOUS - Parties to this Agreement do not intend to create any
rights in any third parties. The obligations of Contractor under this
Section shall survive the expiration, termination, or cancellation of this
Agreement, or any and all other contracts between the parties, and shall
continue to bind Contractor, its agents, employees, contractors,
successors, and assigns as set forth herein if PHI is not returned or
destroyed.
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CONTRACT C2297
ATTACHMENT #2
FINANCIAL AND COMPLIANCE AUDITS
SPECIAL AUDIT REQUIREMENTS
The administration of resources awarded by the Department of Corrections to the
Contractor may be subject to audits and/or monitoring by the Department of
Corrections, as described in this attachment.
MONITORING
In addition to reviews of audits conducted in accordance with OMB Circular A-133
and Section 215.97, F.S., as revised (see "AUDITS" below), monitoring procedures
may include, but not be limited to, on-site visits by Department staff, limited
scope audits as defined by OMB Circular A-133, as revised, and/or other
procedures. By entering into this Contract, the Contractor agrees to comply and
cooperate with any monitoring procedures/processes deemed appropriate by the
Department of Corrections. In the event the Department of Corrections determines
that a limited scope audit of the Contractor is appropriate, the Contractor
agrees to comply with any additional instructions provided by the Department to
the Contractor regarding such audit. The Contractor further agrees to comply and
cooperate with any inspections, reviews, investigations, or audits deemed
necessary by the Chief Financial Office (CFO) or Auditor General.
AUDITS
PART I: FEDERALLY FUNDED
THIS PART IS APPLICABLE IF THE CONTRACTOR IS A STATE OR LOCAL GOVERNMENT OR A
NON-PROFIT ORGANIZATION AS DEFINED IN OMB CIRCULAR A-133, AS REVISED.
1. In the event that the Contractor expends $500,000 or more in Federal
awards in its fiscal year, the Contractor must have a single or
program-specific audit conducted in accordance with the provisions of OMB
Circular A-133, as revised. EXHIBIT 1 to this Contract indicates Federal
resources awarded through the Department of Corrections by this Contract.
In determining the Federal awards expended in its fiscal year, the
Contractor shall consider all sources of Federal awards, including Federal
resources received from the Department of Corrections. The determination
of amounts of Federal awards expended should be in accordance with the
guidelines established by OMB Circular A-133, as revised. An audit of the
Contractor conducted by the Auditor General in accordance with the
provisions of OMB Circular A-133, as revised, will meet the requirements
of this part.
2. In connection with the audit requirements addressed in Part I, paragraph
1., the Contractor shall fulfill the requirements relative to auditee
responsibilities as provided in Subpart C of OMB Circular A-133, as
revised.
3. If the Contractor expends less than $500,000 in Federal awards in its
fiscal year, an audit conducted in accordance with the provisions of OMB
Circular A-133, as revised, is not required. In the event that the
Contractor expends less than $500,000 in Federal awards in its fiscal year
and elects to have an audit conducted in accordance with the provisions of
OMB Circular A-133, as revised, the cost of the audit must be paid from
non-Federal resources (i.e., the cost of such an audit must be paid from
Contractor resources obtained from other than Federal entities).
4. The Contractor may access information regarding the Catalog of Federal
Domestic Assistance (CFDA) via the internet at
xxxx://00.00.000.000/xxxx/xxxx.xxxx.
PART II: STATE FUNDED
THIS PART IS APPLICABLE IF THE CONTRACTOR IS A NONSTATE ENTITY AS DEFINED BY
SECTION 215.97(2)(1), FLORIDA STATUTES
1. In the event that the Contractor expends a total amount of State financial
assistance equal to or in excess of $300,000 in any fiscal year of such
Contractor, the Contractor must have a State single or project-specific
audit for such fiscal year in accordance with Section 215.97, Florida
Statutes; applicable rules of the Executive Office of the Governor and the
CFO; and Chapters 10.550 (local governmental entities) or 10.650
(nonprofit and for-profit organizations), Rules of the Auditor General.
EXHIBIT 1 to this Contract indicates State financial assistance awarded
through the Department of Corrections by this Contract. In determining the
State financial assistance expended in
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CONTRACT C2297
ATTACHMENT #2
its fiscal year, the Contractor shall consider all sources of State
financial assistance, including State financial assistance received from
the Department of Corrections, other state agencies, and other nonstate
entities. State financial assistance does not include Federal direct or
pass-through awards and resources received by a nonstate entity for
Federal program matching requirements.
2. In connection with the audit requirements addressed in Part II, paragraph
1, the Contractor shall ensure that the audit complies with the
requirements of Section 215.97(7), Florida Statutes. This includes
submission of a financial reporting package as defined by Section
215.97(2)(d), Florida Statutes, and Chapters 10.550 (local governmental
entities) or 10.650 (nonprofit and for-profit organizations), Rules of the
Auditor General.
3. If the Contractor expends less than $300,000 in State financial assistance
in its fiscal year, an audit conducted in accordance with the provisions
of Section 215.97, Florida Statutes, is not required. In the event that
the Contractor expends less than $300,000 in State financial assistance in
its fiscal year and elects to have an audit conducted in accordance with
the provisions of Section 215.97, Florida Statutes, the cost of the audit
must be paid from the non-State entity's resources (i.e., the cost of such
an audit must be paid from the Contractor's resources obtained from other
than State entities).
4. For information regarding the Florida Catalog of State Financial
Assistance (CSFA), a Contractor should access the Florida Single Audit Act
website located at xxxx://xxx.xxxx.xxxxx.xx.xx/. or the Governor's Website
located at xxxx://xxxxxxxxx.xxx/x eog/owa/b eog www.html.main page for
assistance. In addition to the above websites, the following websites may
be accessed for information: Legislature's Website
xxxx://xxx.xxx.xxxxx.xx.xx/, Department of Financial Services' Website
xxxx://xxx.xxxxx.xxx/, and the Auditor General's Website
xxxx://xxx.xxxxx.xx.xx/xxxxxx.
REPORT SUBMISSION
1. Copies of reporting packages for audits conducted in accordance with OMB
Circular A-133, as revised, and required by PART I of this Contract shall
be submitted, when required by Xxxxxxx .000 (x), XXX Xxxxxxxx X-000, as
revised, by or on behalf of the Contractor directly to each of the
following:
A. The Department of Corrections at the following addresses:
Internal Audit Contract Manager Contract Administrator
Office of the Inspector General Xxxxx X. Xxxxxxxx Bureau of Procurement & Supply
Florida Dept. of Corrections Office of Health Services Florida Dept. of Corrections
0000 Xxxxx Xxxxx Xxxx 0000 Xxxxx Xxxxx Xxxx 0000 Xxxxx Xxxxx Xxxx
Xxxxxxxxxxx, XX 00000-0000 Xxxxxxxxxxx, XX 00000-0000 Xxxxxxxxxxx, XX 00000-0000
B. The Federal Audit Clearinghouse designated in OMB Circular A-133, as
revised (the number of copies required by Sections .320 (d)(1) and
(2), OMB Circular A-133, as revised, should be submitted to the
Federal Audit Clearinghouse), at the following address:
Federal Audit Clearinghouse
Bureau of the Census
0000 Xxxx 00xx Xxxxxx
Xxxxxxxxxxxxxx, XX 00000
C. Other Federal agencies and pass-through entities in accordance with
Sections .320 (e) and (f), OMB Circular A-133, as revised.
2. Pursuant to Section .320(f), OMB Circular A-133, as revised, the
Contractor shall submit a copy of the reporting package described in
Section .320(c), OMB Circular A-133, as revised, and any management
letters issued by the auditor, to the Department of Corrections at each of
the following addresses:
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CONTRACT C2297
ATTACHMENT #2
Internal Audit Contract Manager Contract Administrator
Office of the Inspector General Xxxxx X. Xxxxxxxx Bureau of Procurement & Supply
Florida Dept. of Corrections Office of Health Services Florida Dept. of Corrections
0000 Xxxxx Xxxxx Xxxx 0000 Xxxxx Xxxxx Xxxx 0000 Xxxxx Xxxxx Xxxx
Xxxxxxxxxxx, XX 00000-0000 Xxxxxxxxxxx, XX 00000-0000 Xxxxxxxxxxx, XX 00000-0000
3. Copies of financial reporting packages required by PART II of this
Contract shall be submitted by or on behalf of the Contractor directly to
each of the following:
A. The Department of Corrections at the following addresses:
Internal Audit Contract Manager Contract Administrator
Office of the Inspector General Xxxxx X. Xxxxxxxx Bureau of Procurement & Supply
Florida Dept. of Corrections Office of Health Services Florida Dept. of Corrections
0000 Xxxxx Xxxxx Xxxx 0000 Xxxxx Xxxxx Xxxx 0000 Xxxxx Xxxxx Xxxx
Xxxxxxxxxxx, XX 00000-0000 Xxxxxxxxxxx, XX 00000-0000 Xxxxxxxxxxx, XX 00000-0000
B. The Auditor General's Office at the following address:
State of Florida Auditor General
Room 401, Xxxxxx Xxxxxx Building
000 Xxxx Xxxxxxx Xxxxxx
Xxxxxxxxxxx, Xxxxxxx 00000-0000
4. Any reports, management letters, or other information required to be
submitted to the Department of Corrections pursuant to this Contract shall
be submitted timely in accordance with OMB Circular A-133, Florida
Statutes, or Chapters 10.550 (local governmental entities) or 10.650
(nonprofit and for-profit organizations), Rules of the Auditor General, as
applicable.
5. Contractors, when submitting financial reporting packages to the
Department of Corrections for audits done in accordance with OMB Circular
A-133, or Chapters 10.550 (local governmental entities) or 10.650
(nonprofit and for-profit organizations), Rules of the Auditor General,
should indicate the date that the reporting package was delivered to the
Contractor in correspondence accompanying the reporting package.
RECORD RETENTION
The Contractor shall retain sufficient records demonstrating its compliance with
the terms of this Contract for a period of 7 YEARS from the date the audit
report is issued, and shall allow the Department of Corrections, or its
designee, CFO, or Auditor General access to such records upon request The
Contractor shall ensure that audit working papers are made available to the
Department of Corrections, or its designee, CFO, or Auditor General upon request
for a period of 7 YEARS from the date the audit report is issued, unless
extended in writing by the Department of Corrections.
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CONTRACT C2297
ATTACHMENT #2
EXHIBIT-1
FUNDS AWARDED TO THE CONTRACTOR PURSUANT TO THIS CONTRACT-CONSIST OF THE
FOLLOWING:
FEDERAL RESOURCES AWARDED TO THE CONTRACTOR PURSUANT TO THIS CONTRACT CONSIST OF
THE FOLLOWING:
Federal State
Program CFDA Appropriation
Number Federal Agency Number CFDA Title Funding Amount Category
------- -------------- ------ ---------- -------------- -------------
------- -------------- ------ ---------- -------------- -------------
------- -------------- ------ ---------- -------------- -------------
------- -------------- ------ ---------- -------------- -------------
STATE RESOURCES AWARDED TO THE CONTRACTOR PURSUANT TO THIS CONTRACT CONSIST OF
THE FOLLOWING MATCHING RESOURCES FOR FEDERAL PROGRAMS:
Federal State
Program Appropriation
Number Federal Agency CFDA CFDA Title Funding Amount Category
------- -------------- ---- ---------- -------------- -------------
------- -------------- ---- ---------- -------------- -------------
------- -------------- ---- ---------- -------------- -------------
------- -------------- ---- ---------- -------------- -------------
STATE RESOURCES AWARDED TO THE CONTRACTOR PURSUANT TO THIS CONTRACT CONSIST OF
THE FOLLOWING RESOURCES SUBJECT TO SECTION 215.97, F.S.:
Catalog of
State
State Financial CSFA Title State
Program State Assistance or Appropriation
Number Funding Source Fiscal Year Number Funding Source Description Funding Amount Category
------- -------------- ----------- ---------- -------------------------- -------------- -------------
------- -------------- ----------- ---------- -------------------------- -------------- -------------
------- -------------- ----------- ---------- -------------------------- -------------- -------------
------- -------------- ----------- ---------- -------------------------- -------------- -------------
Total Award
For each program identified above, the Contractor shall comply with the program
requirements described in the Catalog of Federal Domestic Assistance (CFDA)
[xxxx://00.00.000.000/xxxx/xxxx.xxxx] and/or the Florida Catalog of State
Financial Assistance (CSFA) [xxxx://xxx.xxxx.xxxxx.xx.xx/]. The
services/purposes for which the funds are to be used are included in the
Contract scope of services/work. Any match required by the Contractor is clearly
indicated in the Contract.
DC2-595 (Revised 1-05)
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