Correctional Health Services
Response Form 1 / Pinal County
Finance Department
31 N. Pinal St.
Bldg. A
P.O. Box 1348
Florence, AZ85132
Responder Name: Responder Response
Responders shall complete the following Response Form, indicating their responses in the spaces provided. Additional pages may be added so long as they are clearly referenced in the spaces provided.
Please note: Any exception and the total number of exceptions taken will negatively affect your evaluation score. Compliance to Terms and Conditions has been identified as an evaluation criterion for this solicitation.
Acceptability of Responses
Offers that do not include fully completed copies of Response Forms 1 - 8may cause the entire offer to be deemed unacceptable and therefore non-responsive. Forms with incomplete or unacceptable responses will also be considered non-responsive.
1 Responders Profile
1.1Provide the name of the person who will be the primary Respondent and the address for the primary servicing office. Please also include a resume for major assistants or staff.
Agency Name:
Mailing Address:
City: Sate: Zip Code:
Representative Name: Title:
Phone Number: FaxNumber:
Email Address:
2Minimum Qualifications
Responder shall indicate whether they meet the following minimum qualifications:
2.1Responder has existed for three (3) years or more
Yes No
2.2Responder has a minimum of three (3) years experience in administering and providing a full range of health programs and services to an adult and remanded juvenile population in a jail setting (population greater than 500) in the United States. Full range of service includes essential medical, dental and behavioral health services as defined by NCCHC standards.
Yes No
2.3Responder has a minimum of three (3) years of experience in administering and providing a full range of health programs and services to an adolescent population in a juvenile detention setting or to at risk youth in an alternate setting in the United States. Full range of service includes essential medical, dental and behavioral health services as defined by NCCHC standards. The three years experience must be in the United States.
Yes No
2.4Responder shall demonstrate financial viability by providing:
If publicly traded, a copy of most recent SEC filing
Responder Response
2.5Responder shall provide audited financial statements for the most recent 3 fiscal years with opinion, management letter and notes to the financial statements (for parent company and all subsidiary corporations and specifically identify those corporations operating in Arizona). Include SAS 70/SSAE 16 reports; include the same for unincorporated businesses.
Responder Response
2.6Responder shall provided evidence of ability to secure a performance bond for $1,000,000.
Responder Response
2.7Responder shall provide a listing of fines or penalties paid by the parent company or any regulatory agency during the most recent 3 fiscal years and current year to date. Multiple fines for failure to pay income taxwithholdings timely will cause proposal to be deemed non-responsive.
Responder Response
2.8Responder shall attest their commitment to maintaining NIJO (National Institute of Jail Operations) accreditation at the PCADC and maintaining State of Arizona Juvenile Detention Standards at the PCYJC.
Responder Response
3References
Please list a MINIMUM of three (3), clients for whom you have performed services similar to the Statement of Work in this solicitation.
1. Company Name:
Address:
Contact Person:
Phone: Email Address:
Organization Description:
Capacity and Average Occupancy during most recent year of service:
2. Company Name:
Address:
Contact Person:
Phone: Email Address:
Organization Description:
Capacity and Average Occupancy during most recent year of service:
3. Company Name:
Address:
Contact Person:
Phone: Email Address:
Organization Description:
Capacity and Average Occupancy during most recent year of service:
4.Company Experience
4.1Responder shall provide samples of work performed for current and previous clients who required a similar size and scope of services.
Responder Response
4.2Responder shall describe the modifications they make to their services and programs to address the needs of the juvenile population in detention. Also, explain how age and gender of the juveniles impacts health services provided, if at all.
Responder Response
4.3Responder shall describe any affiliations they have with universities and/or colleges for healthcare training programs including physicians, nurse practitioners, registered nurses or other healthcare positions.
Responder Response
5.Client List and List of Lawsuits and Judgments
5.1Responder shall provide a list of all current and past clients since January 1, 2010. Must include the following information for each client:
- Name of Institution;
- Adult, Remanded Juvenile or Juvenile;
- County/State facility is located;
- Average Daily Population;
- Service provided: Medical, Dental, Behavioral Health, Other;
- Time Period of Services;
- Healthcare licenses held;
- Accreditation; and
- Contact person including current phone number
Responder Response
5.2Responder shall provide a list of all lawsuits and judgments they have been involved in. Response must include the following:
- Plaintiffs;
- Defendants;
- Complaint;
- Judicial Venue;
- Date Filed; and
- Judgment Pending
Responder Response
6.Transition Plan
6.1Responder shall provide a detailed plan for transitioning from Pinal County’s current in-house service model. Be sure to include how current employees will be handled, how quickly services will be established, how staffing will be handled if mass exodus of current staff occurs, plan for learning expectations of Custody for transport, med lines etc and practical furniture, fixtures and equipment considerations.
Responder Response
7.Project Plan
Pinal County Adult Detention Center
Facilities and Equipment
7.1Responder shall provide a list of medical and office equipment purchases they would make or recommend (reference current inventory list Exhibit O – PCADC and Exhibit P - PCYJC).
Responder Response
Receiving and Booking
7.2Responder shall provide a plan for receiving screening including policies, procedures and forms.
Responder Response
7.3Responder shall provide a plan to staff the receiving/booking area to include how the Responder will cover the area if an unexpected influx of bookings occurs.
Responder Response
7.4Responder shall submit the guidelines used to determine if an individual will be diverted to outside medical care before being booked into detention.
Responder Response
7.5Responder shall provide a plan for medical and mental health assessment performed by a RN at intake.
Responder Response
7.6Responder shall provide a plan for managing health needs of detainees in holding area and isolation rooms while they are awaiting initial court appearance.
Responder Response
Physical and Mental Health Assessments
7.7Responder shall provide sample forms used for medical and mental health assessments for adults and juveniles.
Responder Response
Nonemergency Health Care
7.8Responder shall describe the information system they will use to track requests for sick call, triage and scheduling for onsite care. Include a sample report.
Responder Response
7.9Responder shall describe their plan for chronic disease management, including any high volume specialty clinics or mobile services to be provided onsite.
Responder Response
7.10Responder shall describe their plan to manage the outbreak of communicable diseases and achieve compliance with the requirements of the Pinal County Public Health Services District.
Responder Response
7.11Responder shall describe their plan for care of high risk pregnancies.
Responder Response
7.12Responder shall provide their plan for the long term care of stable paraplegics, quadriplegics and other similar cases that may remain in custody for some period of time.
Responder Response
Pharmaceutical Operations and Administration of Medications
7.13Responder shall describe their plan for securing bridge orders for medications for time sensitive health conditions that will need to be administered before detainee can be seen by a prescribing provider. Plan should include administration of critical medications while detainee is held waiting his/her initial appearance.
Responder Response
7.14Responder shall provide plan for administration of medications for detainees including the frequency of passes per day. Provide rationale for proposals with more than two passes per day.
Responder Response
7.15Responder shall provide their proposed process for authorizing medications that are not on the formulary.
Responder Response
7.16Responder shall provide their plan for Keep on Person (KOP) medications, including the list of KOP eligible medications and rationale.
Responder Response
7.17Responder shall describe their plan for discharge medications to include planned (scheduled) and unplanned (not scheduled) discharges.
Responder Response
7.18Is/are the pharmacy(ies) you plan to contract with for routine, urgent and emergent medications able to interface with CorEMR or the Statewide HIE?
Responder Response
7.19Responder shall provide a sample Comprehensive Pharmacy Report. Report should include, at a minimum, all the information in Exhibit G – Sample Pharmacy Report - PCADC.
Responder Response
Diagnostic Testing: Laboratory and Imaging Services
7.20Does the laboratory that you plan to contract with for off-site laboratory tests have electronic interface capability with CorEMR or the Statewide HIE?
Responder Response
7.21Responder shall describe any experience their firm has with telemedicine.
Responder Response
Emergency Services
7.22Responder shall describe their plan for tracking emergency medical requests, including 911 calls, from initial receipt to final disposition.
Responder Response
Behavioral / Mental Health
7.23Respondent shall describe the components of the behavioral health program and behavioral health staffing proposed for adults and remanded juveniles at PCADC.
Responder Response
7.24Respondent shall provide a plan for addressing substance abuse issues. Response shall include approximate cost of the plan.
Responder Response
7.25Responder shall describe the behavioral health criteria they would recommend for admission to and discharge from the administrative segregation unit.
Responder Response
7.26Responder shall describe their firm’s experience with involuntary/civil commitment programs, including the states in which you managed such programs.
Responder Response
7.27Responder shall describe their experience with Restoration to Competency programs and the role they have played in them, if any. Responder will also describe how they will meet the requirements in the Statement of Work for psychiatrist hours and licensed mental health practitioners related to RTC services.
Responder Response
Off-site Services
7.28Responder shall describe the information system they will use to track orders for specialty consults and diagnostic testing, monitor receipt of reports from community providers within 48 hours and consultation and inclusion of reports in the health record. Provide sample reports.
Responder Response
7.29Responder shall provide a plan for Utilization Management to include health care services provided in an inpatient setting as well as outpatient services.
Responder Response
Health Records Management and Health Information Exchange
7.30Pinal County prefers that our existing Electronic Health Record software, CorEMR, be used. However, if proposing another software solution, describe the software solution you propose using. State whether solution is ONC certified.
Responder Response
7.31Responder shall describe their experience with Health Information Exchanges.
Responder Response
7.32Responder shall provide printouts of sample full health records for a patient with significant medical issues and a patient with behavioral health issues.
Responder Response
7.33If not using Pinal County’s CorEMR system, Responder shall provide a detailed implementation and migration plan.
Responder Response
7.34Responder shall describe the technical support that will be available during implementation and 24/7 once implemented for any issues related to EHR.
Responder Response
7.35Responder shall provide their plan for backing up and storing EHR data as well as recovery in the event of a disaster.
Responder Response
Personnel
7.36Responder shall describe their plan for ensuring budgeted staffing levels and thresholds are met.
Responder Response
Quality Assurance / Improvement
7.37Responder shall provide a copy of their Continuous Quality Improvement Plan for correctional health care services.
Responder Response
7.38Responder shall describe the plan for administrative oversight they will use to establish, monitor, manage and take corrective action to ensure compliance with all contract requirements. Responder will also provide an organizational chart that identifies the onsite and corporate positions responsible for reporting, quality monitoring and improvement and other administrative functions associated with this project.
Responder Response
7.39Responder shall identify which, if any, of the Performance Indicators listed in Exhibit C their proposed EHR will not be able to provide information on with a query/report request. How will information for the monthly audits be provided for those Performance Indicators?
Responder Response
Reporting
7.40Responder shall identify which, if any, of the reporting requirements listed in Exhibit E – Required Reports and Reporting Schedule – PCADC their proposed EHR will not be able to provide information on with a query/report request. How will information for the monthly reports beprovided for those data elements?
Responder Response
Coordination with the Court
7.41Responder will describe their plan for coordination with the Superior Court and the Court Clinical Liaison. The County views this as an important partnership.
Responder Response
Pinal County Youth Justice Center
Facilities and Equipment
7.42Responder shall provide a list of medical and office equipment purchases they would make or recommend for the Youth Justice Center (reference current inventory list Exhibit P – Inventory - PCYJC).
Responder Response
Receiving and Booking
7.43Responder shall describe their plan for medical and mental health screening by an RN within one hour of notification, including policies, procedures and forms for the following two alternatives: for only youth admitted to PCYJC and for all youth presenting (physically referred) to PCYJC.
Responder Response
7.44Responder shall provide their criteria for medical intake diversion of arriving youth.
Responder Response
7.45Responder shall submit criteria and description of an alcohol and drug withdrawal program for youth. The program description should include staffing resources, policies and procedures for identification of youth who require management of withdrawal, the onsite testing and other assessments (including offsite) that would be required to determine whether the youth can safely withdraw onsite or requires transport to a hospital for more extensive medical care, and policies and procedures related to managing withdrawal.
Responder Response
Physical and Mental Health Assessments
7.46Responder shall provide sample forms they would use for medical and mental health assessment of youth.
Responder Response
Nonemergency Health Care
7.47Responder shall describe the information system they will use to track requests for sick call, triage and scheduling for on-site care. Include a sample report.
Responder Response
7.48Responder shall describe their plan for chronic disease management.
Responder Response
7.49Responder shall describe their plan to manage the outbreak of communicable diseases and achieve compliance with the requirements of the Pinal County Public Health Services District.
Responder Response
7.50Responder shall describe their plan for care of high risk pregnancies.
Responder Response
7.51Responder shall provide their plan for the long term care of stable paraplegics, quadriplegics and other similar cases that may remain in custody for some period of time.
Responder Response
7.52Responder shall describe the health education they will provide for chronic care populations and prevention of communicable diseases.
Responder Response
Pharmaceutical Operations and Administration of Medications
7.53Responder shall describe their plan for obtaining consent to administer medications from youth’s legal guardian.
Responder Response
7.54Responder shall describe their system for receiving youth’s medications.
Responder Response
7.55Responder shall describe their plan for administering medications to youth housed at the PCYJC, including the frequency of passes per day. Responder must provide justification if proposing more than two passes per day.
Responder Response
7.56Responder shall describe their plan for discharge medications, including the return of medications brought in for youth.
Responder Response
Emergency Services
7.57Responder shall describe their plan for tracking emergency medical requests, including 911 calls, from initial receipt to final disposition.
Responder Response
Behavioral / Mental Health
7.58Responder shall describe their plan for addressing trauma screens and substance abuse issues as part of the overall assessment process.
Responder Response
Off-site Services
7.59Responder shall describe the information system that will track orders for specialty consults and diagnostic testing, monitor receipt of reports from community provides within 48 hours of consultation and inclusion of reports in the health record. Responder shall also provide sample reports from the system.
Responder Response
7.60Responder shall provide a plan for Utilization Management to include health care services provided in an inpatient setting as well as outpatient services.
Responder Response
8Management and Staff Turnover
8.1Responder shall describe how successful they’ve been with recruiting efforts to secure a sufficient number of physicians, psychiatrists, psychologists, nurse practitioners, registered nurses, and other personnel necessary to deliver the volume and quality of services proposed.
Responder Response
8.2Responder shall provide an estimate of turnover rates based on their historical turnover, recruitment and retention experience at similar sites for critical positions: Health Services Administrator, physicians and other prescribing providers, nursing personnel, psychiatrists, psychologists, mental health professionals and other staff critical to providing services. Responder must describe the basis of the turnover rate calculations.
Responder Response
8.3Responder must describe their plan to minimize turnover at Pinal County sites for the contract period.
Responder Response
8.4Offer must describe their transition plan for leadership positions.
Responder Response
8.5Responder shall provide job descriptions with education and experience requirements for each of the following positions: