Microsoft word - addendum 2 to 063-07.doc

The following changes to the bid documents, as specified by this addendum, are as follows: The following is a listing of the questions obtained from prospective bidders before, during, and after the scheduled pre-bid conference and site visit. The deadline for questions was Friday, October 19, 2007. When multiple vendors asked essentially the same question, it has been phrased herein to capture the essence of the question and provide an answer. When one or more vendors asked multiple components of the same essential question, those components were joined into a single question and an answer is provided.
All other terms and conditions of the bid remain the same. Bidders are required to sign this
addendum and attach it to their bid.

COMPANY
NAME: _____________________________________________________________
AUTHORIZED
SIGNATURE: ____________________________________________________________
PRINTED
____________________________________________________________
DATE: _____________________________________________________________
________________________________
Charlene Mischke, Purchasing Director
The answers provided herein are based on the best information currently available to the County, in a good faith effort to strike a legitimate balance between providing sufficient information to allow quality bids to be entered and intruding unnecessarily into the proprietary interests of the incumbent vendor. Two issues are touched upon throughout the questions we received, which we believe justify a preliminary discussion to help put the RFQ and these answers into a cleaner perspective. First, statistics are maintained with the incumbent vendor and County that may be similar to - but not precisely like - information sought in these questions. Due to the relatively compressed timeline involved in this process, we have not required extensive collection and processing of raw data to provide statistical information in the exact form the questions sought. Instead, we have provided statistics as we have them, or have indicated the information is not available. Second, the issue of the payment for offsite medical and catastrophic care services has multiple facets that are easily confused. The County desires for prospective vendors to give us bids assuming three separate options for managing these expenses. These are as follows: 1. There is no aggregate cap fund or per-resident-per-year dollar limit from which the costs for these services are pulled. In this event, the County will pay all of these expenses after the vendor has processed them in accordance with industry standards and Kansas law respecting the application of Medicaid rate. 2. There is an aggregate cap fund in the amount of $250,000.00 from which these costs will be paid. This sum would be paid either as a single lump sum at the beginning of each contract year, or would be paid by the County as part of the monthly base contract fee. If during the contract year the fund were depleted, the vendor would continue to process the claims, and then forward them to the County for payment. Any portion of the aggregate cap remaining at the end of the contract year would return to the County general fund. 3. There is a per-resident-per-year dollar limit of $10,000.00 from which these costs will be paid. An estimate of what this figure would be for each calendar year would be incorporated into each contract year's base fee. If during the contract year the fund were depleted for any individual resident, the vendor would continue to process the claims for that resident, and then forward them to the County for payment. Any portion of the estimated fund remaining at the end of the contract year would return to the County general fund. We hope this explanation of our intent will be helpful in understanding these answers, and in providing a good quality bid. We appreciate the patience of all prospective vendors in walking Q# 1: Appendix D: Physical Plant and Population Information of the RFQ lists the 2006 ADP for the Adult Detention Center (ADC) as 399.9 and the 2006 ADP for the Juvenile Detention Center (JDC) as 39. Section 5, Background of the RFQ states that through December 2006, the average daily populations were 495 for the ADC and 50 for the JDC. Please clarify these significant discrepancies in population for the two facilities. A#1: We apologize for the discrepancies. The following figures for 2005, 2006, and 2007 (through August) are based upon a review of in-house averages (not including those on body receipt): 2005 ADP for ADC = 452, ADP for JDC = 38 2006 ADP for ADC = 434, ADP for JDC = 51 2007 (Jan-Aug) ADP for ADC = 443, ADP for JDC = 50 There is an inconsistency between two locations within the RFQ regarding the intended base contract periods. Is the base contract period for three years (1/1/08 through 12/31/10) or for two years (1/1/08 through 12/31/09)? A#2: The base contract period is for two (2) years (1/1/08 through 12/31/09), with a subsequent option for five additional one (1) year periods. Q#3: Please identify and discuss the specifics of the formula by which the County intends to measure the bids, including what weight will be given for the various components of the formula. A#3: There is not specific formula, including detailed weights applied to various components, whereby the bids will be measured. Instead, the members of the committee who will be reviewing the bids will examine each bid in comparison to the interests of the County in providing these services to the inmates. While cost is important, that factor has to be considered in light of the services being offered and the manner in which each bidder proposes delivering those services. Q#4: Please provide a copy of the current health services contract for the ADC and JDC, including any exhibits, attachments, and amendments. A#4: Due to the concern for maintaining the integrity of the incumbent vendor's internal business processes, County will not provide a copy of the incumbent vendor's contract as part of this RFQ process. Q#5: Please provide the amounts and reasons for any paybacks, credits, and/or liquidated damages the County has assessed against the incumbent vendor over the term of the current contract. A#5: There have been no paybacks, credits, and/or liquidated damages assessed for the incumbent vendor. Q#6: Under section 5.5.5, the RFQ does not address whether the County houses federal (e.g., U.S. Marshal or ICE) inmates, state prisoners, or inmates from other counties. If the County does house such individuals, please provide two years' worth of historical population data broken down by County jurisdiction versus inmates from other jurisdictions. A#6: The responsibility of the agency to pay for the treatment of residents does not change in any way due to the jurisdiction for which we house the prisoner. Having clarified this point, however, here is the information requested: *The high JDC numbers for "Other" is due to overflow juveniles from Johnson County, Kansas. Q#7: For each external agency with which the County has an agreement to provide care to that jurisdiction's inmates, please provide copies of the agreement describing the health services vendor's responsibilities and obligations with regard to those inmates. A#7: The jurisdiction for whom we house residents has no direct impact on the nature or scope of medical services the vendor is required to provide those residents. Accordingly, nothing in our agreements with those entities has any impact on the vendor's obligations. Q#8: What is the County's timeframe for seeking ACA accreditation? Who is responsible for the costs of seeking accreditation? Have there been any specific areas related to medical services identified as obstacles or impediments to accreditation? A#8: By the end of CY2008. The County is responsible for the costs of the auditing process by ACA. The Vendor is responsible for the costs of preparing their records and participating in the audit along side the County. The progression towards ACA accreditation has not progressed far enough to determine if any obstacles or impediments exist in the area of medical services. The current vendor has twice succeeded in obtaining accreditation from the National Commission on Correctional Health Care. Q#9: Please provide copies of the adult and juvenile consent degrees referenced in section 5, A#9: The reference made to the consent decrees was for the purpose of generally giving potential vendors a look at the history of the Department of Corrections. Nothing in the consent decrees resulted in the DOC decision in 2001 to solicit bids for inmate health care services, and they have no impact on any of the decision making related to the selection of a vendor pursuant to this RFQ. Accordingly, copies of the consent decrees will not be provided. Q#10: Is either of the DOC facilities currently subject to any court orders or legal directives? A#10: No. Q#11: Please provide current staffing schedules by shift and day of the week for the ADC and A#11: From the information gathered at the pre-bid conference, we believe the intent of this question is to address the staffing schedule for inmate health services. The Department of Corrections does not direct the schedule for the incumbent provider, except to the extent that they are required to provide the following numbers of service hours per month: Q#12: Does the Department of Corrections feel the current staffing plans for the facilities are A#12: The current staffing plan is based upon the services provided under the current contractual arrangement. Since the services identified in the current agreement do not match those anticipated in the terms of the RFQ, we do not feel it is appropriate to draw a comparison in staffing levels, since it could lead to a misinterpretation of our expectations for purposes of the terms of the RFQ. Q#13: Please provide listings of current vacancies (by position) for the ADC and for the JDC. Which positions have historically been most difficult to fill? A#13: The Department of Corrections does not oversee the staffing activities of the current vendor, except to the extent that they must report the number of hours for each of the categories listed above. There are no known vacancies currently with the incumbent vendor. Historically, the filling of the Director of Nursing and Registered Nurses positions has been a topic of discussion between the Department of Corrections and incumbent vendor representatives. Q#14: Are any of the current health services workforce unionized? A#14: No. Q#15: Please provide current wage/pay/reimbursement/seniority rates (including supplemental pay, on-call pay, shift differentials, travel rates, etc.) for incumbent health services staff at the ADC and at the JDC. A#15: The Department of Corrections does not oversee the staffing activities of the current vendor, with regard to pay rates for their employees. Accordingly, we do not have this information available to provide for purposes of this RFQ. Q#16: Please provide a detailed outline of the security and clearance process for new onsite staff. On average, how long does this process take to complete? A#16: The only part of the security and clearance process that the Department of Corrections has involvement in is the criminal history check. This can typically be completed within one week of receiving the information about the potential employee from the vendor. Q#17: Please confirm that hours spent by health services staff members in orientation, in- service training, and continuing education classes count as hours worked toward the requirements of the contract. A#17: The staffing formula approved via the final contract with the successful bidder will include calculations for all components of staffing maintenance, to allow for sufficient coverage of all necessary functions for the delivery of health care and mental health care for the residents of the ADC and JDC. The training components mentioned in the question will be among those calculations. Q#18: Please confirm who is financially responsible for the following costs: Q#19: Is Internet access currently available to the health unit staff at the ADC and JDC? A#19: The County can provide an unsecured "dirty" internet connection as needed to either or both the ADC and JDC, by linking to a nearby router that does not pass through the County firewalls that provide filters for spam, viruses, or spyware. Any additional hardware that must be installed on the County network for this will be at the cost of Vendor. Alternatively, County will allow Vendor to contract with a provider to drop in a line that is protected by that provider's service, at the cost to Vendor. Q#20: If the County is interested in receiving Electronic Medical Record (EMR) proposals for the ADC and JDC, please provide the following information: […] A#20: County is not interested in receiving EMR proposals as part of the bids submitted in Q#21: Does the County currently utilize telemedicine technology? A#21: No. The County is not interested in receiving and reviewing an optional proposal relating to telemedicine in relation to the current RFQ. Q#22: For the list of medical equipment included in Appendix E: Health Services Equipment Inventory, please indicate whether each piece of equipment is located at the ADC or at the JDC, and identify which equipment will be available for use by the selected provider. If available, please include make, model, age, condition, and current maintenance agreement cost. A#22: All of the equipment listed in Appendix E is owned by the County and will be available to the selected provider. The chart below provides the other information requested, as available: Q#23: Please provide an inventory of office equipment (e.g., PCs, printers, fax machines, copiers) currently in use at each facility and identify which equipment will be available for use by the selected provider. If available, please include make, model, age, condition, and current maintenance agreement cost. A#23: The office PCs and printers (that are not owned and maintained by the current vendor) are owned and maintained by the County through the IT department. The fax machines, and copiers are leased by the County, and are maintained through the lease agreement. The PCs are all HP DC7600s, purchased in 2006 and on an automatic recycling schedule through the County IT. The printer is an HP LaserJet 5, purchased in 1996, and will be considered for replacement as needed. Both fax machines (one ADC, one JDC) are Canon Laser 2050s, installed in 2002. The copier leased by the County is a Ricoh FT4522. Q#24: Are radiology, laboratory, and dialysis services currently provided onsite or offsite? Please provide contact information for the current sub-contracted provider for these services. A#24: All radiology, laboratory, and dialysis services are provided offsite, and the determination of which vendors in the community will provide those services vary based upon arrangements made by the incumbent provider, and are not limited to any vendor by pre-established contractual arrangement. The passage of Kansas House Bill 2893 in 2006 disposed of the need to make contractual arrangements with vendors when covered services are provided. Dialysis services are provided by vendors in accordance with the level of security required for the inmate needing the service. Q#25: With regard to section 5.3.14, Ancillary Services of the RFQ, which states that the vendor shall be responsible for the provision and payment of all offsite laboratory, x-ray, and other ancillary services: a. Please confirm that dialysis services are not considered to be ancillary services, and remain the financial responsibility of the County. b. Please confirm that section 5.3.15 does not refer to laboratory, x-ray, and other ancillary services related to inpatient hospital stays, and that such services remain the financial responsibility of the County. A#25: First, it must be stressed that the RFQ countenances that the County be ultimately responsible for payment of all offsite services provided to residents of the ADC and JDC (except where unreasonable delay in payment results in the vendor bearing responsibility for payment of a claim), with statutory reimbursement from those residents being sought as allowed. The import of this section is that the vendor is responsible to make sure these services are provided and that the vendors are properly paid, initially via the aggregate cap or per-resident cap, and (if needed) subsequently via proper processing bills for forwarding to the County for timely payment. Those services arranged for by vendor can include all of these ancillary services whether inpatient or outpatient. So long as the timely provision is made for the processing and payment of the bills, the County will be fully responsible for payment of those bills. If the vendor fails to ensure timely payment of the bills for any of these offsite services, vendor will then be responsible for payment of those bills without the ability to pass those expenses back to the County. Q#26: What are the designated emergency or "911" hospitals for the ADC? For the JDC? Please provide the provider agreement or other contract under which these services are provided. A#26: Stormont-Vail Regional Medical Center is utilized for all resident emergency transports, whether ADC or JDC residents. This is due to the fact that they are one of only two local emergency providers, and the other provider is utilized by County personnel for treatment of duty-related emergency medical needs and occupational health services. There is no provider agreement or contract with Stormont-Vail Regional Medical Center. Q#27: Regarding onsite clinics at the ADC and JDC: a. What specialty care/chronic clinics are currently held onsite? Please provide information on these clinics' frequency, number of hours per week, and utilization. b. What additional clinics, if any, at how many hours per week, would the DOC wish the A#27: A: See the chart below for the information on current clinics, as requested: B: The current schedule of clinics is based on the current provision of services and the current number of inmates. The County is not specifically seeking a replica of the current system, or recommending any specific change in that system. Rather, the County seeks to receive bids from the prospective vendors that will be based on their independent assessment of the best way to provide the services identified in the RFQ. Q#28: Please provide a breakdown by gender and diagnosis of the current Special Needs population at the ADC and at the JDC (e.g., those residents who require special housing or care due to age, infirmity, or mental or physical disability). A#28: This specific information is not maintained in the format requested, and therefore will not be provided for purposes of this RFQ. Please refer to the charts in response to question #48 for statistical information that is available. Q#29: With regard to the 40-bed Special Management Unit and 35-bed Medical Living Unit (M-Module) at the ADC, how are the beds allotted between male/female residents? How are the beds allotted to various levels of medical health status (e.g., how many beds are for observation, how many for housing chronically ill or impaired residents, etc.)? A#29: There are no mandatory allotments for either of these housing units. We generally attempt to make separation between males and females to ensure no unauthorized fraternization, but when necessary, we will utilize the bed space for a resident of any status. There are also no mandatory allotments related to the level of care needed. Generally, if we are able, we house inmates who have a higher probability of needing medical attention in M-Module so that we facilitate access to health care staff. M-Module is NOT an infirmary and we do not attempt to utilize it as such. Inmates that require a higher degree of chronic or acute medical care are transported to a hospital or (if court ordered) to a hospice facility. Q#30: With regard to the 14-bed special housing unit at the JDC, how are the beds allotted between male/female residents? How are the beds allotted to various levels of medical health status (e.g., how many beds are for observation, how many for housing chronically ill or impaired residents, etc.)? A#30: There are no allotments relative to the use of the juvenile module nominated D-Module (Delta). There are also no mandatory allotments related to the level of care needed for the juvenile residents housed there. All female juvenile residents are housed in the juvenile female housing unit (Alpha), regardless of any low-level, chronic medical condition needing observation. With juvenile residents, we maintain a lower threshold before transporting for care at a hospital or hospice facility, due to the difficulty in providing close-at-hand medical observation. Q#31: Please describe the medical acuity level the Special Management Unit, m-Module and the JDC Delta Module unit can handle without the need to send an inmate or juvenile resident for offsite care (e.g., can any of the units administer intravenous (IV) medications? Nasogastric (NG) feedings? Total parenteral nutrition (TPN), etc.)? A#31: No. These are resident housing units, and do not serve in any capacity similar to an Q#32: Does the ADC have a mental health unit, or beds assigned to mental health patients? If "yes," please provide the number of such beds, and indicate how the beds are allotted between male/female residents. How are the beds allotted to various levels of mental health status, (e.g., how many beds are for crisis stabilization, how many for transitional care, etc.)? A#32: The ADC does not have a "mental health unit". Generally, inmates with severe enough mental health problems to interfere with their capacity to function with normalcy in general population are housed in the Segregation module for males or C-Module for females (if the condition results in violent outbursts) or in the Medical (M-Module) unit. Higher functioning mentally ill residents can generally function in a module where Close Observation residents are housed (e.g., K-Module for males and Y-Module for females). Occasionally the ADC will have a high enough concentration of higher functioning mentally ill residents to allow for one of the modules to be opened for housing just this population, but it is not typically the case. Q#33: Does the JDC have a mental health unit, or beds assigned to mental health patients? A#33: No. If a juvenile resident has low function, he/she would either be observed more closely in one of the modules, or the holding authority would be asked to have him/her placed in a more stable environment for the mental health condition. Q#34: Does the DOC currently offer a methadone treatment program for female offenders who are both pregnant and addicted to opioids? A#34: No. Q#35: Does either the ADC or JDC currently have a DEA registration? A#35: The current provider maintains the DEA registration for the storage and distribution of Q#36: Does either the ADC or JDC currently have a state-licensed pharmacy permit? A#36: The current provider maintains a state-licensed pharmacy permit. Q#37: How are medications distributed and where does medication distribution take place? How often is medication distributed each day? How long does it take to perform the average medication distribution process? A#37: The resident medication is distributed through med passes three times daily. In addition, when medications are distributed as part of sick call, it is administered in the medical services area of either the ADC or JDC. Med pass typically takes one to one and a half hours, depending upon the activities in the facility at the time. Q#38: Who administers medications (RN, LPN, or medical assistants)? A#38: LPN is the lowest level medical professional authorized to distribute medications. Q#39: Do the facilities have medication carts that will be made available for the use of the A#39: Yes. Q#40: Does either facility currently maintain a Keep-On-Person (KOP) program? If not, is the DOC interested in implementing a KOP program at either facility? A#40: Only some topical ointments/creams or inhalers are allowed to be maintained in the module with the residents, as directed by the medical health authority. Due to the risk to safety and security, the DOC is not interested in initiating a KOP program as part of this RFQ. Q#41: Please provide copies of the current formulary utilized at the ADC and JDC, and a sample of a current formulary management report. A#41: The formulary for pharmaceuticals used in performance of the current contract is proprietary to the current vendor's business operation and therefore will not be provided as part of this RFQ. Q#42: Please identify the name of the current primary pharmacy service provider. Please identify and provide contact information for the current local back-up pharmacy. A#42: Current primary pharmacy services provider is Maxor Correctional Pharmacy Services. Current back-up provider is Walgreens Pharmacy, 1001 SW Topeka Blvd., Topeka, KS 66612, (785) 354-1470. Q#43: Please provide a list of the top 25 most utilized prescription medications at the ADC and A#43: The top 25 most expensive medications are identified below, generated for the most recently reported month's usage. This information is not separated between ADC and JDC because the current vendor provides pharmaceutical services from a single common source out of the ADC: Q#44: Please provide statistics on the number of residents prescribed atypical anti-psychotics as a percentage of all residents who are prescribed psychotropic drugs. A#44: The information is not maintained in the form requested. However, the majority of the antipsychotic medication prescribed is atypical to the formulary designed by the current vendor. Q#45: Please provide a list of all drugs currently kept as stock medications at the ADC and A#45: All medications maintained by current vendor are stock medications. Q#46: By facility, what is the average number of residents receiving pharmaceutical treatment A#46: See the statistical information provided in response to question #48 Q#47: For the annual psychotropic and other medication costs provided in Appendix D: Physical Plant and Population Information for the ADC and JDC, please indicate what percentage of each cost was attributable to the ADC versus the JDC. A#47: The information is not available in the form requested. All medications are stocked by the current vendor for both ADC and JDC from a centralized pharmacy. Q#48: In addition to the information in Appendix D: Physical Plant and Population Information for the ADC and JDC, please provide the following monthly statistical data by facility for 2006 and year-to-date 2007: a. Number of inpatient offsite hospital days d. Number of trips to the emergency department e. Number of ER referrals resulting in hospitalization g. Number of times air transport was utilized (including cost/frequency) k. Average number of diabetics on oral vs. insulin medications per month l. Average number of diabetics per month m. Average number of asthmatics per month o. Average number per month of residents undergoing dialysis treatment A#48 These statistics are not maintained by County in the specific descriptions identified. On the following pages, you will see the statistical information collected under the procedures established with the current vendor. 992 981 993 921 868 942 1000 941 962 858 755 785 10998 417 359 284 277 292 326 282 308 365 318 235 304 153 177 182 156 156 190 157 208 188 205 187 148 191 174 147 221 168 165 206 161 152 196 162 178 458 441 414 419 390 403 474 430 457 471 465 443 117 132 146 147 162 118 124 178 142 172 154 109 # of Residents on Daily Med/15th/month 17 Q#49: In addition to the information in Appendix D: Physical Plant and Population Information for the ADC and JDC, please provide 2006 and year-to-date 2007 health services costs for the following categories: A#49: The requested information is not maintained by the County in the manner requested. The costs provided for offsite medical services of all kind for 2006 is $960,906.75 and for year-to-date 2007 is $103,839.02. The primary purpose for the significant drop in this figure is the application of the new Kansas statute requiring vendors to be paid at the Medicaid rate for services provided to inmates and juvenile residents. Q#50: Please provide data on the average monthly number of claims submitted by community hospitals, physicians, and other practitioners for care provided to inmates. A#50: The requested information is not maintained by the County in the manner requested. Q#51: Please indicate which of the following categories of health care costs are included under d. Other offsite diagnostic services (e.g., offsite radiology, MRI, PET, etc.) e. Dialysis services (should the County classify these as ancillary services) A#51: All offsite medical services for ADC and JDC residents should be subject to bid whether those services are paid via a $10,000.00 per resident per year cap, a $250,000.00 aggregate cap, or no cap with County making payment of all off site medical claims after processing by the successful bidder. Q#52: Please clarify that there is no section 4.6 in RFQ section IV. A#52: There is no section 4.6 in the RFQ. Q#53: In Section V: Statement of Work, there are two sections 5.3.18 (Mental Health Services and Pharmaceutical, Medical Supplies, and Equipment) and two sections 5.3.19 (Medical Records and Health Education) as well as the irregularity of having section 5.3.19 Medical Records reference sub-section 17 rather than 19. A#53: For purposes of bidding, vendors should consider the following sections nominations: 5.3.18A Mental Health Services (with each subsection bearing the nomination of "A" at the end of the 3rd level subsection "18"). 5.3.18B Pharmaceutical, Medical Supplies, and Equipment (with each subsection bearing the nomination of "B" at the end of the 3rd level subsection "18"). 5.3.19A Medical Records (with each subsection bearing the nomination of "A" at the end 5.3.19B Health Education (with each subsection bearing the nomination of "B" at the end Under section 5.3.19A, those subjections should include: 5.3.19A.1 Emergency Information Transfer (with it's subsections carrying the The bids will be reviewed closely for the content of the bid (in these sections), more so than for the nominations of these sections and subsections. The County apologizes for the error in nominations and the confusion it may have led to. Q#54: Would County consider receiving tables of contents with an affidavit that they are true and accurate representations of the manuals requested in sections 5.3.13 and 5.3.14? A#54: County is willing to receive these tables of contents, taken with affidavit, for purposes of the bid only. For any bidder being examined more closely for purposes of potential contract, County reserves the right to require production of the entire manual for review as necessary part of contract negotiation and/or finalization. Q#55: Will County consider reducing coverage to the level of $1,000,000.00 per occurrence and $3,000,000.00 aggregate for insurance requirements under section 4.5.3.6.2? For purposes of bids, County will consider the $1,000,000.00/occurrence, $3,000,000.00/aggregate as satisfactory insurance coverage capacity for the vendor. Q#56: Can the required Performance Guarantee, in section 3.2, be substituted for another form of security, such as a certified letter of credit or corporate guaranty? A#56: Yes. County will consider other forms of performance guarantee besides a performance bond, for purposes of bidding. In the event of actual contract, the guarantee will be negotiated. Q#57: Please provide the titles, credentials, and job descriptions with a list of the services performed, for the four mental health professionals currently employed by the County (referenced in section V). Also, are these the same mental health staff referenced in section 5.3.18 Mental Health Services (nominated for bid purposes as section 5.3.18A)? A#57: The four mental health professionals employed by the County were identified in the booklet provided at the pre-bid conference. They provide general counseling and referral services for residents, focusing primarily on the severely mentally ill and residents on suicide watch and close observation. In the past one-year period, the mental health professionals working with ADC residents had 6,274 documented contacts with inmates, while they had 1,388 documented contacts in the same time period with juveniles. Q#58: In section V, the following language appears: "As part of the contract, all claims for offsite medical services are processed through the vendor for proper coding and compliance with Kansas law which requires certain resident health care services to be billed at Medicaid rates. Claims cleared through this process are forwarded to the department for final approval and payment, so that residents may then be billed for provision of these services while in the department's custody." Please provide answers to the following questions related to this language: a. What is the Kansas statute referenced? b. Which residents will be billed for services? c. What services are to be billed to residents? d. What is the policy/methodology for determining responsibility for payment? e. Does the provision for billing residents apply to juveniles in custody? B. All ADC residents who receive offsite medical services C. All offsite medical services, except when the medical services are required due to the negligence of DOC staff or an unprovoked attack from another resident. D. If an ADC resident receives offsite care, and it is not due to the negligence of DOC staff or an unprovoked attack from another resident, the resident is responsible for payment of the offsite medical service costs. Q#59: Is the medical records unit currently supervised by an individual with ART credentials? A#59: Yes. Q#60: In section 4.5.3.3.1, the RFQ requires a quarterly report of "costs related to specified diagnoses." What costs are included? Please provide a copy of a recent report. A#60: This report is not required under the current contract, so there is no copy or sample to Q#61: Will County accept a 120-day without cause termination right for either party or an annual renewal of the contract by mutual agreement clause? A#61: The County would be willing to discuss with the successful bidder the inclusion of a term of this nature in the final contract. However, the County does prefer a 180-day provision in this regard, to give sufficient time for selection of and transition to a replacement vendor. Q#62: Are OTCs available through the commissary? If so, please provide a listing. A#62: The following OTCs are available through our commissary vendor: Q#63: What form are psychotropic medications dispensed in - liquid or tablet? A#63: Tablet Q#64: Please provide the additional 2006 and year-to-date 2007 monthly or annual statistics for b. Mental health indicators (evaluations, # on psychotropic medications, psychiatry visits, and mental health visits by vendor staff) b. See tables associated with question #48. c. In 2006 (4 suicide attempts); in 2007 (4 suicide attempts) d. 2006 (1 by natural causes), YTD 2007 (0) Q#65: Please identify the providers for each type of offsite medical services A#65: Primary providers include: Radiology and Nuclear Medicine of Topeka This is not an exhaustive listing, but are vendors who typically appear on billing reports Q#66: What is the procedure for inpatient mental health confinement of an inmate outside of the facility? Who is responsible for payment for these services. A#66: There is no local inpatient mental health confinement of an inmate in our custody. Those who are required to go through inpatient mental health evaluation or treatment, as a component of their pre-trial or pre-sentence processing, are transported to the Larned State Mental Hospital in Larned, Kansas. Since transports there are in accordance with court order, the state pays for the costs of this housing. Q#67: Identify the provider of emergency transports. A#67: American Medical Response (AMR). Q#68: Please provide additional information about the planned expansion of facilities: c. Description of either replacement or expansion of the medical unit A#68: A. November 2007 through November 2008 B. 240 minimum custody beds is the maximum capacity of the new facility Q#69: When does the "official" booking occur? When does the contractor's responsibility for A#69: For purposes of onsite medical care, the County assumes control over the inmate when he/she is taken from the arresting agency in the vehicular sally port. If an inmate requires evident emergent medical care (an assessment made by vendor staff), he/she is transported by the arresting agency and returned upon release by the medical authority (hospital). When an arrestee is transported for medical care prior to being brought to our facility, we are still responsible for payment of those medical services (offsite medical services) if the following conditions are met: 1. The arrestee is being arrested for a violation of state statute (instead of local ordinance, state parole hold, or federal warrant). 2. The arrestee is eventually brought to our custody on that arrest (i.e., was not released after signing a ticket at the hospital, and later brought here on a warrant for the same case). The successful bidder will be responsible for processing these claims in the same manner that offsite medical claims initiated by the vendor from inside the facility. Q#70: Who currently performs the receiving screening? A#70: LPN or higher level health care provider Q#71: When does TB and STD testing occur? Is HIV testing offered to all admitted inmates? A#71: TB testing is done during the receiving screening. STD testing occurs at this time if indicated, or during the physical performed within 14 days of receiving. HIV testing provided to any inmate as requested or indicated. Q#72: When are physical exams completed? Who completes the health history? Who performs A#72: Physicals are completed within 14 days, or earlier if necessary for placement of an inmate into a work program. LPN or higher level health care provider completes the health history. Specially certified RN or ARNP conducts the examination. Q#73: How does the frequency of sick call (section 5.3.5 - 5 days a week) differ from current A#73: There is no difference. Q#74: Is there currently an electronic time record system being utilized? If so, where is the time A#74: The current vendor has an electronic time record system for their staff. It is located on the insecure side of PSVB (accessible if employees enter from the back parking or front parking areas). Q#75: Are medical forms the responsibility of the vendor or are forms specific to the DOC? A#75: Vendor will provide all forms utilized in the provision of health care and mental health Q#76: Can County provide the KDHE regulations referenced in the RFQ? A#76: Kansas Department of Health and Environment regulations for Detention and Secure Care Centers for Children and Youth at the following website address: http://www.kdheks.gov/bcclr/regs/detentionandsecurecare.html, where you will find the applicable regulations available in.pdf format. Q#77: How many County employees will participate in the annual TB testing requirement in the A#77: For FY2008, the DOC will have 272 staff members eligible to participate in the annual testing requirement. This number will change as the staffing pattern of the agency is altered over time. Q#78: Who is the current vendor, and what has the County paid that vendor in the past five A#78: Prison Health Services has provided health care and mental health services to DOC for the past five years. Each year's contract price is as follows: Q#79: In section 4.1.1 (i), what is the criteria by which the vendor will be measured? What specifically does the vendor have to be in compliance with? A#79: As explained during the pre-bid conference, this provision is in anticipation of certain health care or mental health services being directly related to the ability of the County to obtain or maintain federal grant or contractual funds. Presently, there are no such requirements, because the County has not yet entered into any arrangements for grant or contract funds that relate in any way to the health care or mental health services provided by the current vendor. If such an event is anticipated, the representatives of the vendor will be given appropriate notice, and be given opportunity to meet the necessary requirements either within the scope of the original agreement, or via an amendment to the original agreement. Q#80: Are the therapists referenced in section 4.5.1 included in the current vendor's staff? A#80: Without providing information regarding the specifics of the incumbent vendor's staffing patterns, the provision of therapy services is a part of the current vendor's contract. Q#81: What specific population for the ADC and JDC should the proposal be based on? A#81: Appendix C1 - C5 includes population ranges for the first five years of an anticipated contract with the successful bidder. On each of those sheets, we anticipate the bid to reflect prices for provision of services within each of the ranges identified for both the ADC and JDC. This will allow the County to anticipate what the costs would be if the ADC or JDC population experiences any radical increase or decrease in population. The final terms under which increases or decreases would be triggered will be negotiated as part of the final agreement with the successful bidder. Q#82: Section 5.3.17.1 indicates that the vendor would arrange for eyeglasses to be purchased. Does this mean that the vendor would be responsible for the cost? A#82: No. The County will forward all offsite medical services costs for payment. The vendor would be responsible to ensure the service is provided, since vision care is considered a part of the services provided under the terms of this RFQ. Q#83: Is there an OB/GYN on the current staff? A#83: No. Q#84: Please provide the number of births to inmates the jail has experienced in the past five A#84: Three. One took place in the facility; the others took place at Stormont-Vail Regional Medical Center. Q#85: Does section 5.3.21.3 refer to the payment increase above the regular monthly payment A#85: The purpose of this section is to allow the vendor to be compensated when scheduled increases in population result in anticipated increases in services provided. When these increases are automatically triggered (by increases in population), the vendor and County will review the vendor's staffing to determine what additional staff the vendor will require to meet the additional demand. Once that is determined, the additional costs paid by the County will be paid out at 50% until the new staffing levels are met. This is to create a motivation on the part of the vendor to rapidly increase their staff to meet the new demand, rather than re-deploying current staff away from "less important" functions in order to meet primary care needs of the increased population. If the County is going to pay for the increase in services, we should be able to have staff available to ensure the increased load is being met. Q#86: Will the County accept fixed monthly reimbursement with a variable population per A#86: For purposes of the bid, the County will not consider this proposal. If the successful bidder seeks to make a proposal of this nature during final negotiations, the County will hear the proposal and make any decision with respect to this idea at that time. Q#87: Under section 5.3.18.2 (now nominated section "5.3.18B.2"), which of the following is a. The DOC plans to carve out pharmacy costs to re-bid this service annually b. The vendor is required to bid this out annually c. Continuous daily review of the medications available on the commodities market, resulting in lowest daily cost, will be sufficient A#87: The terms of this provision reflects that the County intends that the vendor will competitively bid the provision of pharmaceuticals annually, to ensure we have the best price available in the market. Q#88: Please explain section 5.5.8 of the RFQ. A#88: The intent of this RFQ is to require the vendor to provide a 24-hour period during which a newborn child will have his/her care paid for, in the event no family member is available to assume care of the child. If a child has no individual to assume it's care, the state will assume custody of the child, at which time the vendor will no longer have responsibility for ensuring payment for that care. Q#89: Please define the data processing requirements associated with the performance of this A#89: The use of databases, or other proprietary technology to perform the services anticipated in this RFQ is exclusively in the domain of the vendor. The County assumes the successful vendor is in the business of providing correctional health care and mental health services, and has designed business protocols and systems to effectuate performance. The County does not require the use of any system owned and operated by the county, except to the extent the successful vendor's personnel will be required to learn and navigate through the inmate management system (to retrieve inmate data for their use), and to make use of standard information systems software (e.g., Microsoft Office programs for document production and electronic communications). Q#90: Under the terms of section 4.4 of the RFQ, will potential vendors be allowed access to current vendor's employees prior to submission of the bid? A#90: The incumbent vendor will not be required to make their staff available for purposes of this section of the RFQ, except as part of the transition process in the event that a different vendor is selected. In that event, only those employees of the incumbent vendor who agree to be contacted by the successful vendor will have his/her contact information provided. Q#91: Under section 5.3.11.1, does the current vendor's contract contain an aggregate cap provision for offsite medical bill payment? A#91: No. Q#92: Under section 5.3.18.6 (now nominated section "5.3.18B.6"), is the practice of providing a seven (7) day supply of prescribed medications upon discharge currently in place? If yes, how are the discharge medications packaged? Approximately how many discharge medications being issued monthly? A#92: Yes. These medications are provided in bottled pill form. The number of discharge medications being handled monthly is not specifically tracked, but estimated to be approximately 12 per month. Q#93: Under the provisions of section 5.3.21.2, has the current vendor incurred staffing penalties? If yes, in what amount for 2006 and year-to-date 2007? A#93: Yes. 2006 $2,568.00. Year-to-date 2007 $7,713.50. Q#94: Under section 5.3.25, is the current vendor utilizing an Electronic Medical Records program? If yes, what is the name of the program and who owns the software? A#94: Yes. County does not own or operate the program, so we have no actual information regarding the name or nature of the software. Q#95: Under section 5.4.5.2; in the event of transition from the current vendor to a new vendor, how will pharmaceuticals, stock meds and medical supplies be handled during the last third (30) days of the contract? Will a supply be available at the commencement of services to a new vendor or will the new vendor need to supply? A#95: There are no specific provisions in the current vendor's contract in this regard. In the event this issue needs to be addressed, the County and the current vendor will negotiate (with the input of a replacement vendor) on these matters. Q#96: Please provide a list, without inmate names, of all inmates who have exceeded the $10,000.00 in offsite care and how many total dollars were spent on each. A#96: There is currently no per resident, per year cap or aggregate cap applied to the payment Q#97: Have you had any dialysis cases over the past year? If so, where were they handled? A#97: We have utilized Kansas Dialysis Services, and when security measures have mandated higher levels of security, we've coordinated with the Kansas Department of Corrections to make use of their dialysis services. Q#98: Please confirm that the vendor is responsible for provision of Psychiatrist and that all other mental health staff are the county's staff. A#98: Vendor is responsible for provision of psychiatric services (whether via psychiatrist exclusively, or in combination with a psychiatric ARNP). The four mental health staff referenced in the RFQ are employees of the County and are in no way managed, supervised, or paid by the vendor. Q#99: Under section 5.5.8 of the RFQ, please provide the amount spent on the first 24 hours of newborn care in each of the past three years. Has the County completed a mock ACA survey? d. In the past year, provide the number of pregnant inmates and total days of A. We utilized Lincoln Center OB/GYN and Topeka OB/GYN B. We do not know C. No D. Number of days for pregnant inmates is not tracked. You can see the statistics provided in answer to question #48 for pregnant inmate contacts. Has the County established the medical criteria for referral for hospital treatment? All medical service decisions are left in the hands of the medical service provider, who assumes all liability in the event of a finding that their criteria is negligent or deliberately indifferent. The County has not mandated any criteria in this regard. The criterion established by the incumbent vendor is proprietary and will not be provided as part of this RFQ. Please explain the current agreement with respect to pharmacy and the cost of pharmaceuticals. If there is a cap on pharmacy costs, has it been exceeded? If so, what is the pharmacy cap? What is the amount of costs above the cap? There is a cap, and it has not been exceeded. Please provide a listing of all participants in the pre-bid conference and site visit The following table identifies all vendor representatives at the pre-bid conference In addition, the Department of Corrections was represented by Dir. Dick Kline, Maj. Eve Kendall, Maj. Brian Cole, and Captain Timothy Phelps. Shawnee County Purchasing Department was represented by Dir. Charlene Mischke.

Source: http://www.co.shawnee.ks.us/purchasing/Bids/2007/063-07-addendum2.pdf