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CONTRACT # C1938 Amendment # 1

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CONTRACT AMENDMENT BETWEEN

THE DEPARTMENT OF CORRECTIONS

AND

WEXFORD HEALTH SOURCES, INC.

This is an Amendment to the Contract between the Florida Department of Corrections (“Department”) and Wexford Health Sources, Inc. (“Contractor”) to provide comprehensive healthcare services for the East and West clusters in the Department’s Region IV.

This Amendment: • revises Section II., 8., paragraphs one, two, three, & four, D., Services to Be

Provided; • revises Section II., 9., d)., D., Services to Be Provided; • revises Section III., A., Payment; • adds Section VII., Y., No Third Party Beneficiaries; and • replaces Attachment A with Attachment A, Revision 1, to add DC #403, South

Unit, add DC#481, Martin TC unit, increase Department’s capacity Broward CI. Original Contract period: July 1, 2001 through June 30, 2006

In accordance with Section V., Contract Modifications, the following changes are hereby made: 1. Section II., 8., D., paragraphs one, two, three, & four, Services to Be Provided, is revised to read: II. D. Services to Be Provided

8. Inmate Health Services

The Contractor shall provide comprehensive and medically necessary physical, dental and mental health services pursuant to the provisions of this Contract. The Contractor shall be responsible for all inmate medical costs for care provided, which includes, but is not limited to, inpatient and outpatient care, emergency services and care, pharmaceutical services, initial intake screening for physical, dental and mental health pre-existing conditions, detoxification of substance abusers and provision of eyeglasses (when medically required), hearing aids and dentures. The only exceptions will be for regularly scheduled outpatient renal dialysis, related shunt care, hospitalization for End Stage Renal Disease (ESRD), care for newborns after birth, as well as organ transplants. The Department agrees to reimburse the Contractor the actual costs related to the placement/blockage/infection of shunts necessary to perform routine hemodialysis and any hospitalization costs specific to a primary diagnosis of End Stage Renal Disease (ESRD). Documentation must be patient specific with actual hospital billing documents and include an invoice from the Contractor. This includes reimbursement for female dialysis patients or for male patients with emergent needs prior to movement to NFRC.


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The Department agrees to provide the work-up for Hepatitis C treatment through the North Florida Reception Center (NFRC) hospital facility by referral from the Contractor for such procedures as GI Scan, abdominal ultrasound and liver biopsy at no cost to the Contractor. The Department will reimburse the Contractor on a direct cost basis for the medications related to the treatment of Hepatitis C (HCV) to include Ribavirin and the various forms of Interferon, including pegylated Interferon. The costs of routine monitoring of HCV patients through laboratory procedures shall be borne by the Contractor. This documentation must include the patient name, number and costs of the medications for HCV treatment, Ribavirin and Interferon of the prescribed form, and the actual billing information to substantiate the medication expense. The Contractor will make every effort, in coordination and cooperation with the institutional Warden, to administer required healthcare as is practical to inmates housed in the confinement or close management units, at those locations. This includes Sick Call. The Warden will make every effort to provide appropriate facilities at the respective housing unit.

2. Section II., 9., d)., D., Services to Be Provided, is revised to read: II. D. Services to Be Provided

9. Physical Health Services

d) Testing for HIV infection, which will be done in accordance with applicable State and

Federal Law and Department Policies and Procedures.

The Department agrees to reimburse the Contractor for actual testing expenses for pre-release inmates to include HIV testing, related diagnostic testing and HIV medications during incarceration and for thirty (30) days after release. Each inmate tested as pre-release (not for HIV voluntary testing for other purposes) should be listed with a check-off for the tests administered and for the medications initiated. All information must be verifiable within OBIS and by checking the medical record and be submitted to the Department on a monthly basis (the month following completion) with the routine invoice for adjustment to contract payment. The Department will provide a format for monthly submission of actual testing and medication costs related to the pre-release HIV program. The Contractor must provide initial one-time validation of the direct expense related to each test and medication listed. The Department will not reimburse the Contractor for the minimal labor costs related to the specimen collection or pre or post-test counseling.

3. Section III., A., Payment, is revised to read: III. A. Payment

The Department will compensate the Contractor for the provision of comprehensive healthcare delivery services that meet the requirements of this Contract as specified in Section II, Scope of Work. Payment will be made monthly at the per diem rate 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. Payment for each facility shall begin at 12:01 a.m. on the implementation date as indicated in Section II., C., Implementation Plan or the actual date of implementation in the event of delay.


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Per Diem (Per Inmate Per Day) Contract Year

East Cluster West Cluster

Initial

Contract Price

Amendment # 1 Price effective

3/01/03

Initial Contract

Price

Amendment. # 1 Price effective

3/01/03 Year 1 7/1/2001 –6/30/2002 $12.92 $7.30 Year 2 7/1/2002 – 6/30/2003- $13.31 $13.41 $7.52 $8.06 Year 7/1/2003 – 6/30/2004 $13.71 $13.81 $7.75 $8.30 Year 4 7/1/2004 – 6/30/2005 $14.12 $14.22 $7.98 $8.55 Year 5 7/1/2005 – 6/30/2006 $14.54 $14.65 $8.22 $8.80

Optional Renewal Period Year 1 7/1/2006 – 6/30/2007 $14.98 $15.09 $8.47 $9.06 Year 2 7/1/2007 – 6/30/2008 $15.43 $15.54 $8.72 $9.33 Year 3 7/1/2008 – 6/30/2009 $15.89 $16.01 $8.98 $9.60 Year 4 7/1/2009 – 6/30/2010 $16.37 $16.49 $9.25 $9.89 Year 5 7/1/2010 – 6/30/2011 $16.86 $16.98 $9.53 $10.19

NOTE: The three percent (3%) annual increase is included in prices for each additional year and optional renewal year. 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 last payment of the Contract will be withheld until all pending adjustments have been determined and reconciled.

4. Section VII., Y., No Third Party Beneficiaries, is added to read: VII. 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.

This Amendment shall begin on the date on which it is signed by both parties. All other terms and conditions of the original Contract remain in full force and effect.


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IN WITNESS THEREOF, the parties hereto have caused this Amendment to be executed by their undersigned officials as duly authorized. CONTRACTOR: STATE OF FLORIDA WEXFORD HEALTH SOURCES, INC. DEPARTMENT OF CORRECTIONS SIGNED SIGNED BY: BY: NAME: NAME: James V. Crosby, Jr. TITLE: TITLE: Secretary Department of Corrections DATE: DATE: FEID #: 59-2363973 APPROVED AS TO FORM AND LEGALITY SUBJECT TO EXECUTION BY THE PARTIES Louis A. Vargas General Counsel Department of Corrections

Contract #C1938 Facilities List, Cluster Demographics and Functional Capacities Attachment A, Revision 1

Revision 1, Page 38 of 40

East Cluster CAPACITIES SPECIALTIES/FUNCTIONAL CATEGORIES

DC # Institution Male/ Female

Maximum Institutional

Capacity

Maximum Facility

Capacity

Proposed Expansion /

Date

Average Daily

Intakes CM-1 CM-2 CM-3 PM TCU

CapacityCSU

Capacity S-3 X (3,4) HIV

475 Broward F 753 753 2 39 14 400 64 54 419 Dade Main F 2,057 668 6 6 6 300 72 77 463 Dade Annex M 1,325 400 241 217 426 Big Pine Key R.P. M 64 401 Everglades M 1,805 1,805 112 112 110 400 307 276

406 Glades M 1,447 918 142 July-2004 145 ---

462 Glades WC M 287 431 Loxahatchee R.P. M 92 469 West Palm Beach WRC M 150

418 Indian River M 486 486 149 Nov-2001 --- ---

430 Martin M 1,648 1,300 129 Oct-2003 224 86 130 166 200 208 187

481 Martin TC Unit 129 420 Martin WC M 264 444 Fort Pierce WRC M 84

402 SFRC M 2,036 1,317 879 Jan-2004 20 47 150

403 South Unit 889 446 Hollywood WRC M 84 452 Atlantic WRC M 45 457 Miami North WRC M 191 459 Miami WRC M 37 465 Pomp Beach WRC M 212 473 Opa Locka WRC M 150

TOTALS 11,121 0 22 342 204 246 166 39 61 1,850 1,037 811



West Cluster CAPACITIES SPECIALTIES/FUNCTIONAL CATEGORIES

DC # Institution Male/ Female Maximum

Institutional Capacity

Maximum Facility

Capacity


Date

Average Daily


CapacityCSU


510 Charlotte M 1,410 1,290 112 112 111 48 52 500 206 185 544 Ft. Myers WC M 120

560 Desoto Annex

M

1,711 1,327

223 Sept-2002

223 Jan-2003

564 DeSoto WC M 288 241 525 Arcadia R.P. M 96 501 Hardee M 1,724 1,436 112 84 56 563 Hardee WC M 288

576 Hendry M

1,573 1,225

561 Hendry WC M 280 527 Copeland R.P. M 68

404 Okeechobee M 1,378 1,378 263 Dec-2001 132 86 172

TOTALS 7,796 7,796 0 356 282 339 0 48 52 500 447 185

Notes: 1) RP = Road Prison, WC = Work Camp, WRC = Work Release Center 2) HIV capacity is a sub-total of the Medical Grade (X) capacity

3) The proposed expansion of SFRC is tentative

Contract #C1938

Page 1 of 40 MODEL DOCUMENT REVISED 6/1/00

CONTRACT BETWEEN

THE DEPARTMENT OF CORRECTIONS

AND

WEXFORD HEALTH SOURCES, INC. This Contract is between the Florida Department of Corrections ("Department") and Wexford Health Sources, Inc. ("Contractor") which are the parties hereto.

WITNESSETH Whereas, the Department is required to ensure that all inmates are provided care, custody, treatment, housing, and general handling in accordance with Section 945.04, Florida Statutes; Whereas, it is necessary that budget resources be allocated effectively; Whereas, this Contract is procured as a result of the Department’s Request for Proposal (RFP) #00-DC-7342, authorized pursuant to Section 287.057(2), Florida Statutes; and; Whereas, the Contractor is a qualified and willing participant with the Department to provide Comprehensive Healthcare Services for the East and West clusters in the Department’s Region IV. Therefore, in consideration of the mutual benefits to be derived herefrom, the Department and the Contractor do hereby agree as follows: I. CONTRACT TERM AND RENEWAL

A. Contract Term This Contract shall begin on July 1, 2001, or the date on which it is signed by both parties,

whichever is later, and shall end at midnight on June 30, 2006. In the event this Contract is signed by the parties on different dates, the latter date shall control.

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 ninety (90) days prior to the Contract expiration date.

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II. SCOPE OF WORK

The Contractor shall provide comprehensive healthcare services which shall include, but not limited to, physical, dental and mental healthcare, which meet or exceed the levels specified in the Department’s Request For Proposal # 00-DC-7342 and all Addenda thereto, which documents are incorporated herein by reference and made part of this Contract. Additionally, the Contractor’s proposal is incorporated into and hereby made a part of this Contract. Should there be any conflict in language, this Contract will govern, followed by the Department’s Request for Proposal #00-DC-7342 and then the Contractor’s proposal.

A. Authority/Rules/Regulations

The Contractor will be required to meet all federal and state statutory and regulatory requirements regarding the provision of comprehensive healthcare in an institutional setting and must maintain full accreditation by the American Correctional Association (ACA) in all institutions in which the healthcare services are being provided. Currently, all institutions in Region IV are ACA accredited. Failure to maintain accreditation may result in the assessment of liquidated damages as set forth in Section VII., W., Liquidated Damages. The above authority, rules and regulations are incorporated herein by reference and made a part of this Contract. Should the above authority, rules or regulations change during the course of this Contract, the updated regulations and requirements will take precedence. The Contractor and the Department shall work cooperatively to ensure a high standard of service delivery and compliance with all Federal, State of Florida and Department laws, statutes, rules, policies and procedures. Any changes in the scope of service required to ensure continued compliance with State or Federal laws, statutes or regulations, or Department policy or regulations will be made in accordance with Section V., Contract Modifications. The Department reserves the exclusive right to make certain determinations regarding the service requirements outlined in this 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.

B. Facilities List, Cluster Demographics and Functional Capacities

The Contractor shall provide comprehensive healthcare services including, but not limited to, physical, dental and mental healthcare, to the inmates at the designated institutions and facilities operated by the Department in Region IV, as listed in Attachment A. If the inmate workload capacities listed under “Specialties/Functional Categories” on Attachment A are exceeded the Contractor shall notify the Contract Manager. Upon notification, the Department shall take appropriate action to reduce the specialty/functional category(ies) to capacity or lower. The Department will strive to ensure that the inmate workload capacities are maintained at or below the listed capacities. The following reports will be utilized to determine capacities of total population and specialty/functional categories.

Contract #C1938


1. Average Daily Population Report

2. DC524, Facility Populations Screen

3. DC Run 604 – Capacity Forecast for Inmates Type X-3, X-4, Special Needs and S-3’s

4. GHS 19 – Chronic Illness Clinics (includes HIV report)

5. HS 54 – Report Medical Grades by Facility

6. IMONE033 – For Health Services Only (for monitoring purposes) Special Need Exceptions Report

C. Implementation Dates The Contractor shall assume complete responsibility for the delivery of healthcare at the following institutions at 12:01 a.m. on the implementation date listed below:

Facility Implementation Date Cluster

Everglades Correctional Institution July 16, 2001 East

Glades Correctional Institution July 23, 2001 East

Charlotte Correctional Institution July 30, 2001 West

Dade Correctional Institution August 13, 2001 East

Martin Correctional Institution August 27, 2001 East

Indian River Correctional Institution August 27, 2001 East

South Florida Reception Center September 10, 2001 East

DeSoto Correctional Institution September 24, 2001 West

Hendry Correctional Institution September 24, 2001 West

Hardee Correctional Institution September 24, 2001 West

Broward Correctional Institution October 8, 2001 East

Okeechobee Correctional Institution October 8, 2001 West

D. Services to Be Provided

1. Standards

a) All medical services shall be provided at a minimal constitutionally adequate level of care and shall be compatible with the current standard Medicaid Service level of healthcare adjusted and enhanced to address the differences in demographics between the general population receiving Medicaid services and the inmate population. Florida Medicaid Service Levels are set forth in the current version of “The Florida Medicaid Summary of Services” and appropriate coverage and limitations handbooks promulgated by The Agency for Healthcare Administration and available on their Internet web-site (www.fdhc.state.fl.us/medicaid). It should be noted that some of the service limitations, service settings and coverage described in these publications are not applicable to this Contract. An appropriate enhancement of the Medicaid service levels is therefore required to address the differences in programs, populations and types of required services to ensure that inmates have complete and full access to minimal constitutionally adequate levels of

Contract #C1938


healthcare. The Department’s Resource Materials (refer to Section 1 “Definitions” of RFP 00-DC-7342) will be provided to assist in meeting this requirement. Due to the unique requirements of correctional healthcare, some Health Services Bulletins will require complete compliance by the Contractor. These are listed in the sections below.

b) Documentation of licensure and accreditation for all hospitals, clinics and other providers utilized must 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 VI., A., Department’s Contract Manager.

2. Administrative Requirements, Space, Equipment and Commodities

a) The Contractor shall designate a Chief Health Officer (CHO) or Administrative Designee who will submit monthly reports to the Department’s Contract Manager or Designee and Director of Health Services for all clinical matters. The Warden of each institution is required to submit a monthly commentary on the overall performance of the healthcare provider to the Contract Manager, Healthcare Contract Monitoring Team and the Director of Health Services.

b) The Department reserves the right for any Department staff to make scheduled/unscheduled or announced/unannounced visits to the contracted site.

c) The Contractor shall represent the healthcare unit in discussions with local civic groups or visiting officials of the Department as mutually agreed upon by the parties.

d) The Contractor’s CHO or Designee shall have direct oversight of and shall monitor the performance of all healthcare personnel rendering direct patient care.

e) The Contractor shall comply with applicable continuing requirements as determined by the Director of Health Services for reports to and from the Department, Correctional Medical Authority and the Healthcare Contract Monitoring Team.

f) The Department will provide for the Contractor’s use, an office within the health services unit for administrative use at the following institutions: Charlotte Correctional Institution, Martin Correctional Institution, and Everglades Correctional Institution. The institution shall provide and maintain presently available and utilized space, non-healthcare equipment, furniture, fixtures and other items for the efficient operation of the healthcare unit that are currently in the institutional health services unit. A physical inventory of all healthcare equipment will be taken after the Contractor assumes responsibility for healthcare services. Any medical equipment not available in the institutional health services unit upon the effective date of the Contract and required to provide healthcare services under the terms of the Contract, will be the responsibility, and shall be provided at the expense, of the Contractor. A list of the equipment available at each institution is included in Composite Attachment 9 of the RFP. Equipment shall be properly maintained and replaced as needed by the Contractor and shall become the property of the Department upon expiration or termination of the Contract. Equipment is defined as any item with a unit cost exceeding $1,000.

g) All pharmaceuticals and medical supplies, including prosthetic devices (dental and medical), shall be provided by the Contractor. The Department will inventory, package and remove all pharmaceuticals and medical supplies not required by the Contractor. This will be done in coordination with the Contractor. Any Pharmaceuticals or medical

Contract #C1938


supplies that the Contractor wishes to retain in accordance with the RFP the Department will invoice the Contractor at Cost of the pharmaceuticals or medical supplies. If a private contractor assumes responsibility from another private contractor, coordination and arrangements shall be made between the Department and incoming Contractor, for payment to the Department of existing to-be-transferred supplies and drugs. There should be at least a (30) days’ supply of medical supplies and drugs when the Contractor assumes responsibility. A physical inventory of all equipment, drugs and medical supplies will also be conducted upon the expiration or termination of the Contract with appropriate credit payable to the Contractor. The term "medical supplies" is defined as all medical equipment and commodity items with a unit cost of less than $1,000.

h) The Contractor shall utilize Department forms. The Department shall provide all forms that are required to carry out the provisions of the Contract.

i) The Contractor shall not be responsible for housekeeping services, food/dietary services, building maintenance, bed linen and routine transportation.

3. Personnel, Orientation, Staffing and Security

a) The Contractor shall give Department healthcare employees, affected by this privatization initiative, first consideration for employment.

b) The Contractor shall use qualified personnel licensed by the State of Florida to provide professional healthcare coverage 24 hours a day, 7 days a week at each institution. The Contractor shall employ only candidates who have appropriate Florida licensure and certification and who have provided documentation of past healthcare experience. Each candidate will be subject to a credentials review and approval process with individual certification that the employee has the requisite training, experience and licensure or certification necessary to perform the duties assigned. The credentials process must meet or exceed the requirements of Florida Law. All Physicians, Advanced Registered Nurse Practitioners (ARNPs), Psychologists, Psychological Specialists, Physicians’ Assistants and Dentists or clinical equivalents of these position titles employed by the Contractor shall be credentialed. The Contractor shall provide a certification statement on each individual to the Director of Health Services certifying that the credentials of each individual have been reviewed and he/she is certified as qualified to perform the duties assigned. Current security clearances and professional credentials, except for OBIS profiles, shall remain in effect for contracted staff. The final selection of all employees and subcontractors 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 this Contract. The Department shall not employ criteria to approve or disapprove the selection of employees and subcontractors that expose 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.

c) Contractor staff shall adhere to the standards of conduct in Chapter 33-4, Florida Administrative Code, any Code of Ethical Conduct applicable to the staff member's licensure or credentials, and Florida Department of Corrections' personnel policy and procedure guidelines, (particularly rules of conduct, employee uniform and clothing requirements and security procedures) and any other applicable rules, regulations, policies and procedures of the Department.

d) In addition, the Contractor shall ensure that all staff or individuals performing services under or in relation to the Contract adhere to the following requirements:

Contract #C1938


1) The Contractor's staff shall not display favoritism to, or preferential treatment of, one inmate or group of inmates over another.

2) The Contractor’s staff shall not deal with any inmate except in a relationship

that will support the approved goals of the Contract. Specifically, staff members shall never accept for themselves or any member of their family, any personal (tangible or non-tangible) gift, favor or service, from an inmate or from an inmate's family or close associate, no matter how trivial the gift or service may seem. All staff shall be required to report to the Warden or their designee any violation of these restrictions. In addition, no staff shall give any gifts, favors or services to inmates, their family or close associates.

3) 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.

4) The Contractor’s staff shall not have outside contact (other than incidental

contact) with an inmate, their family or close associates, except for those activities that are to be rendered under this Contract.

5) 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 his/her employees avoid both misconduct and the appearance of misconduct.

6) 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 designee, including proposed action to be taken by the Contractor. Any failure to report a violation or take appropriate disciplinary action against the offending party or parties shall subject the Contractor to appropriate action, up to and including termination of this Contract.

7) The Contractor shall report any incident requiring investigation by the

Contractor in writing to the Warden and Contract Manager, within 24 hours of the Contractor’s knowledge of the incident.

4. Contractor Staff Employment Regulations

a) Criminal Records Check: The Contractor’s staff assigned to this project 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 background check findings or the criteria for disqualification or removal. In order to carry out this background check, the Contractor shall provide, upon request, the following data for any individual Contractor’s or subcontractor’s staff assigned to the Contract: Full Name, Race, Sex, Date of Birth, Social Security Number, Driver’s License Number and State of Issue. The Contractor’s staff shall submit to fingerprinting by the Department of Corrections for submission to the Federal Bureau of Investigation (FBI) on all temporarily approved new hirees. The Contractor shall not consider new employees to be on permanent status until a favorable report is received by the Department from the FBI.

Contract #C1938


b) The Contractor shall ensure that the Warden or Designee and Contract Manager is provided the information needed to have the NCIC/FCIC background check conducted prior to any Contractor staff being hired. The Contractor shall not offer employment to any individual who has not had an NCIC/FCIC background check conducted.

c) No employee who has been barred from any Department institution or other facility shall be considered for employment at another Department contracted facility.

d) The Contractor shall not employ any individual at any program site under this project who is under supervision or jurisdiction of any parole, probation or correctional authority. Persons under any such supervision may work for other elements of the Contractor’s agency that are independent of the contracted program. 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 record of the Department of Corrections’ inmates sentenced to sites included under this Contract.

e) The Contractor shall disclose any business or personal relationship a Contractor staff person, officer, agent or potential hiree may have with anyone presently incarcerated or under the supervision of the Florida Department of Corrections.

f) The Contractor shall require employees to immediately report any new arrest, criminal charges or convictions and shall inform the Warden and the Contract Manager accordingly.

g) The Contractor shall not assign personnel to this contract who are either convicted felons or have relatives confined by or under supervision of the Department, without immediate notification and approval of the Contract Manager and the Warden.

h) Personnel files on all contract employees shall be on file with the healthcare unit of the institution. The records shall be made available to the Healthcare Contract Monitoring Team, institutional Warden or Designee, the Regional Medical Executive Director and Director of Health Services 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.

i) Each on-site CHO at each institution shall serve as the medical authority and shall work as a team with the Department’s administrative and clinical managers and the Healthcare Contract Monitoring Team. Each CHO shall operate the clinical healthcare program in accordance with the standards set forth in Section II., A. Authority/Rules/Regulations and Section II., D., 1. Standards above and all applicable State Laws, Regulations, Departmental Rules, Policies and Procedures, Technical Instructions and ACA standards and will adhere to any additions or changes thereto.

j) Each on-site CHO, or designee, shall plan, implement, direct and control all clinical aspects of the institutional healthcare program. 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.

k) The Department’s Healthcare Monitoring Team is headed up by the Regional Medical Executive Director, who is the clinical monitor of the institution and as such will be the designee/representative of the Director for Health Services for monitoring clinical care. The Regional Medical Executive Director shall keep the Director of Health Services apprised of all clinical issues, problems or other matters that impact healthcare at the institution.

l) The Contractor shall provide its physicians with a beeper service so that they may be contacted while off-site.

Contract #C1938


m) The Contractor shall notify in writing and consult with the Warden or designee and the Director of Health Services or Designee prior to discharging, removing or failing to renew the contracts of, professional staff.

n) The Contractor and its personnel 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.

o) The Department will provide security for the Contractor’s employees and agents consistent with the security provided at other Department facilities.

p) The Department reserves the right to request the removal from the Contract of any employee, in writing, without cause. The Contractor must comply within ten (10) calendars days from receipt of the request.

5. Training and Education

a) The Contractor shall be responsible for ensuring that all new healthcare personnel are provided the following training. (However, the Contractor is not required to duplicate training for employees previously employed by the Department.)

1) Orientation and appropriate training regarding on-site medical practices at each institution. Additionally, the CHO shall receive the same orientation training given to other CHOs by the Office of Health Services.

2) One time Mandatory Training as prescribed for all Department employees, including 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.

3) Annual In-service Training as prescribed for all Department employees. All full-time healthcare staff shall receive 40 hours of in-service training per year with the exception of clerical, who shall receive 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.

b) The Contractor is advised 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 property and responsibility of the Contractor. The library should contain, at a minimum, basic reference texts related to diagnosis and treatment in a primary care setting, as well as a current medical dictionary, pharmacology reference book and a Physician's Desk Reference. Copies of Department Resource Materials will be provided upon request, at the expense of the Contractor.

c) The Contractor shall distribute a written job description to each member of the healthcare staff that clearly delineates his/her assigned responsibilities. The Contractor shall monitor performance of healthcare staff to ensure adequate job performance in accordance with these job descriptions and other provisions of this Contract.

d) The Contractor shall ensure that staff performing services under the Contract are trained in the following areas:

Contract #C1938


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 requested and agreed upon by the institution’s Warden,

Director of Health Services, and the Contractor’s staff.

6. Information Technology

a) Information Technology (IT) Equipment The Contractor shall utilize and maintain the basic component of Information Technology (IT) equipment available at each institution. If the Contractor determines the need for additional or updated equipment to ensure contract compliance, other than the Department’s expansion of programs or population, it shall be the responsibility, and shall be provided at the expense, of the Contractor. Such equipment is to be compatible with current State Technology Office information technology hardware/software architectural standards and will become the property of the Department upon expiration or termination of this Contract. Any additional IT equipment required by the Department will be the responsibility of and at the expense of the Department.

b) Training The Contractor shall make available appropriate personnel for training in the Health Services component of the Offender Based Information System (OBIS-HS) that will be provided by the Department. Training will be conducted in Olustee, Florida or at each institution, if possible. Personnel required to attend include the Data Entry Operators, Health Services Administrator, Medical Records Supervisor and any personnel entering or accessing data in the OBIS-HS system. The Contractor is responsible for payment of travel expenses for its employees. The Contractor shall ensure that one employee from each discipline (per institution) complete this training within the first ninety (90) days of this Contract.

7. Reporting

The Contractor shall ensure that all required Health Service reporting is accomplished. The following reports and data entry shall be completed, filed or submitted by the Contractor as specified below:

a) Cost Reporting The Contractor shall provide to the Healthcare Contract Monitoring Team, Contract Manager, and the Deputy Director, Health Services Administration quarterly (calendar year) reporting of its operating costs for each institution. Reports should be submitted in the same format as the Department of Corrections’ Health Services Expenditures Fiscal Year 1999-2000 East/West Cluster Reports contained in Composite Attachment 9. Any changes made to this format by the Department during the term of the Contract shall also be made by the Contractor. Reports shall be due quarterly, to be submitted on or before the 15th of April, July, October and January of each year of the contract with the first report due April 2002.

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b) Audited Financial Statements The Contractor and its parent company, the Bantry Group corporation, shall have an annual financial audit performed by an independent Certified Public Accountant (CPA). The audit shall cover the Contractors’ entire fiscal year. The scope of the audit performed shall include the financial statements and a report on internal control and compliance. Compliance findings related to contracts with the Department shall be based on the Contract’s requirements, including any rules, regulations or statutes referenced therein. The Contractor shall submit copies of the audit report and a management review letter signed by the CPA directly to the Contract Manager and the Department’s Office of Internal Audit at 2601 Blair Stone Road, Tallahassee, Florida 32399-2500, within 180 days after the end of the Contractors’ fiscal year.

c) Quality Management Report Clinical Quality Management Reports shall be properly completed and submitted as required by the Department’s Quality Management procedure to the Deputy Director of Health Services Administration and the Office of Health Services, Quality Management Coordinator. OBIS-HS Health Service Reporting The Contractor shall maintain and be in compliance with all elements of the Health Services component of the Offender Based Information System (OBIS-HS). The program shall be maintained and compliance met in accordance with the OBIS-HS Technical and Procedures Manual and all applicable directives issued by the Department. Such operation shall include all current applications and such applications as may be implemented during the course of the Contract.

8. Inmate Health Services

The Contractor shall provide comprehensive and medically necessary physical, dental and mental health services pursuant to the provisions of this Contract. The Contractor shall be responsible for all inmate medical costs for care provided, which includes, but is not limited to, inpatient and outpatient care, emergency services and care, pharmaceutical services, initial intake screening for physical, dental and mental health pre-existing conditions, detoxification of substance abusers and provision of eyeglasses (when medically required), hearing aids and dentures. The only exceptions will be for regularly scheduled outpatient renal dialysis and care for newborns after birth, as well as organ transplants. The Contractor will make every effort, in coordination and cooperation with the institutional Warden, to administer required healthcare as is practical to inmates housed in the confinement or close management units, at those locations. This includes Sick Call. The Warden will make every effort to provide appropriate facilities at the respective housing unit.

a) Initial Health Assessments – Intake Process In accordance with HSB 15.03.13, each inmate shall receive initial comprehensive physical, dental and mental health assessments upon incarceration. The results shall be recorded in the inmate’s medical record. This initial assessment during the intake process applies only to the reception centers at Broward Correctional Institution and South Florida Reception Center in the East Cluster.

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1) 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 physical, dental and mental health services in accordance with specified healthcare standards set forth in Section II., D., 1. Standards above and consistent with maintaining a minimal constitutionally adequate level of care.

2) HSB 15.03.13 defines the procedures for assigning functional grades 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. The medical (X) grading system is as follows:

X-1: The individual possesses a high level of physical fitness and,

consequently, is medically fit for any assignment.

X-2: The individual meets acceptable standards, but possesses some medical condition or physical defect that may impose some limitations on assignment.

X-3: The individual has medical condition(s) or physical defect(s) that require certain restrictions in assignment to insure reasonable availability of care.

X-4: The individual has one or more severe medical conditions or physical impairments that require assignment restrictions to insure continuous monitoring of that condition or conditions.

An overall functional 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 functional grade is appropriate, changes may only be made by a physician, 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 in the absence of a psychiatrist or psychologist. Either a physician, dentist, clinical associate, or a psychologist may change an "X" grade after coordination, but only based upon a valid medical or mental health limitation.

3) 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.

4) Certain institutions in the twelve institutions in Region IV will house inmates

classified in all medical grades and mental health grades. Institutional capacities of medical and mental health grades can be found in Attachment A, “Facilities List, Cluster Demographics and Functional Capacities”.

b) Medical Records The Contractor shall ensure that all healthcare unit staff document each healthcare encounter in the Problem-Oriented Medical Record, utilizing the SOAP 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.

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1) The Contractor shall ensure that each medical 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 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 as described in Section II., D., 18. Quality Management.

3) The Contractor shall ensure that each medical record meets the requirements of

Florida Statutes and the Department’s Resource Materials. 4) The Contractor shall include all logs required in medical and mental health areas,

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 in a timely manner.

5) It is the intent of the Department to adapt an existing automated medical record

system for use at all institutions in Florida. Initially, a model Electronic Medical Record (EMR) system will be set up among four institutions outside of Region IV and the Central Office. Subsequent to satisfactory outcomes of this model system, budget authorization will be requested for the implementation of a total EMR system throughout the state. Accordingly, the Contractor will be required to be compliant with the requirements of this system at such time as it is implemented.

9. Physical Health Services

The Contractor shall ensure that physical healthcare is delivered to inmates in a manner that complies with all state and federal laws, Department Rules and Policies and Procedures and the standards set forth in Section II., A. Authority/Rules/Regulations and Section II., D., 1. Standards. In addition to these requirements, the Contractor will be responsible for the following:

a) Sick call, which shall be provided in compliance with Internal Directives of the Department. b) Access to specialty care through regularly scheduled chronic illness clinics and other

specialty clinics as necessary, conducted under the direct supervision of the CHO for the following conditions: 1) Asthma/Pulmonary 2) Diabetes 3) General Medicine e.g. cardiovascular, gastrointestinal, endocrine, genitourinary,

chronic liver disease 4) Hypertension 5) INH Therapy 6) Immuno-deficiency 7) Seizure Disorder

These clinics are to be operated and care is to be provided in accordance with the Florida disease management initiative as recommended by the Florida Medicaid Reform Task Force in March 1997, to address the special needs of Medicaid individuals living with chronic illnesses. Subsequent to this recommendation, the Florida Legislature authorized disease management and that same year directed the Agency for Healthcare Administration to "select methods for implementing the program that included best

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practices, prevention strategies, clinical-practice improvement, clinical interventions and protocols, outcomes research, information technology, and other tools”. The Florida disease management initiative 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.

c) An infectious disease education program for inmates that will be consistent with the Department's existing health education program for HIV and AIDS as described in Section 945.35, Florida Statutes.

d) Testing for HIV infection, which will be done in accordance with applicable State and Federal Law and Department Policies and Procedures.

e) Infirmary care shall be available for those inmates requiring skilled nursing care, chronic illness care, convalescent care and all acute and chronic conditions that can be managed on-site. Infirmary care is available and required to be utilized at all Region IV institutions except Indian River Correctional Institution. The institutional infirmary capacities can be found in the attached Monthly Workload and Utilization Reports. In administering infirmary care, the Contractor shall ensure the following is provided:

1) When the infirmary is occupied, 24-hour coverage will be maintained on-site by a Registered Nurse;

2) Daily infirmary rounds by nursing staff; 3) 24-hour Physician on-call coverage; 4) A manual of nursing care procedures; 5) A separate and complete medical record for each patient; and 6) Infirmary rounds will be conducted by the Physician no less than one (1) time

per day, Monday through Friday.

f) Documentation in the inmate's medical record of all infirmary encounters by a healthcare provider working for, or on behalf of, the Contractor.

g) Monitoring of all infirmary cases to ensure that inmates who meet generally accepted standards for hospital admission are not inappropriately maintained in the infirmary.

h) Referral of the inmate to a community provider facility that can provide the necessary treatment, if in the opinion of the on-site CHO, the inmate cannot be properly treated in the institutional infirmary. Any such facility must be mutually agreed upon by the Department and Contractor to provide hospital-based services for the Department's inmates. A list of Department contracts with community provider facilities will be made available to the Contractor. The Contractor shall be financially responsible for all costs associated with the care of an inmate treated in a community provider facility.

i) The Contractor may utilize the Department’s current health 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. The contractor will be required to utilize a hospital housing a secure prison ward when possible to minimize security costs unless other arrangements to contain such costs are made and approval is obtained in writing from the Contract Manager. If the Contractor identifies another hospital in either cluster that could be used in a similar manner, it may contract for that hospital’s services, subject to prior Department approval.

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j) The Contractor may utilize the services available at the Department’s North Florida Reception Center (NFRC) medical complex in Lake Butler. The procedures for accessing and utilizing these services are outlined in HSB 401.005 Utilization management – Coordinating Health Services for Inmates in Contract Institutions. A schedule of services available and associated charges will be provided to the Contractor upon request. Any inmate transferred to NFRC under this arrangement will remain the financial responsibility of the Contractor and will be returned to Region IV upon completion of treatment.

k) Hospitalization of inmates requiring care beyond the capability of the infirmary which shall be at a community provider facility licensed to provide inpatient hospital services. Inpatient hospital services are medically necessary services provided under the direction of a physician or dentist in a hospital maintained primarily for the care and treatment of patients with disorders other than mental diseases. These 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 minimal 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 North Florida Reception Center in a timely manner. Recommendations for hospitalization, with the exception of emergency situations, shall require review and approval by the on-site CHO. Hospital admissions that arise from emergency situations shall be reviewed by the on-site CHO within forty-eight (48) hours of admission and reported to the Department’s Utilization Management Program within the same time frame.

l) Non-routine (emergency or urgent) transportation of inmates as outlined in Section II., D., 10. Emergencies. 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.

m) Review of the healthcare status of inmates admitted to outside hospitals to ensure that the admission is medically necessary, and the length of stay appropriate.

n) Development of Utilization Management Policies and Procedures regarding referral methods, scheduling, transportation, reporting of test results, medical records, acute care hospitalization and patient follow-up. The Department’s Utilization Management Procedures may be used.

o) Treatment, care or procedures, including but not limited to, surgery and prosthetics, initiated at the institution, which 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 of the provision of completing appropriate care is the responsibility of the Contractor.

p) Healthcare and related services for all inmates at road prisons, work camps and work release centers assigned to institutions in Region IV, except for inmates covered by insurance or workers’ compensation. Services may be provided in the community and billed to the Contractor or, depending on circumstances, with the approval of the Regional Medical Executive Director and Transfer Coordinator, the inmate may be returned to the responsible institution. The Contractor and the Director of Health Services or Designee will agree upon these situations on a case-by-case basis.

q) Referral of inmates requiring hospitalization or other specialty care in follow-up to a previous surgery or procedure that occurs out of the respective cluster to the provider or facility originally providing the service.

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r) Establishment of regular meetings with representatives from the Office of Health Services, the designated hospital and other providers to coordinate the referral of inmates. The Contractor shall inform the Warden of these meetings. The Warden or designee, and the Regional Medical Executive Director or designee may attend. The Contractor or designated institutional representative shall meet monthly with the Regional Health Services Manager and weekly with the institutional Warden.

s) Eye examinations which shall be performed on-site in accordance with ACA Standards and HSB’s 15.02.10 and 15.03.05. A qualified Optometrist shall examine inmates with specific complaints.

t) Ophthalmic prosthetics clinically mandated by an Ophthalmologist and services (including prosthetics) necessary to the continued provision of needed healthcare for the inmate. Non-clinically mandated ophthalmic prosthetics shall be provided at the inmate’s expense. Eyeglasses shall be provided through PRIDE.

10. Emergencies

a) 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 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 all costs of emergencies, including air ambulance and/or land ambulance transportation.

b) 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 Department’s Visitors.

c) The following service requirements shall be met to ensure that qualified emergency treatment is provided:

1) In-service education on first aid and emergency procedures. 2) Written policies and procedures concerning emergency transfer and transportation of

inmates. 3) Arrangements for emergency 24 hour on-call physician coverage. 4) Coordination with security for arrangements when the emergency transfer of an

inmate is indicated. 5) Cardiopulmonary Resuscitation (CPR) Basic Training for all Health Services

staff and other designated Departmental staff members.

11. Mental Health Services

a) The Contractor shall ensure that inmate mental healthcare is delivered in a manner that complies with all state and federal laws and the standards set forth in Section II., D., 1. Standards. The Department's publication, "Mental Health Services Plan," provides guidelines on how the Department has organized its mental healthcare system. Inmates are assigned to an institution according to the mental health grade assigned during the health assessment each inmate receives upon incarceration. The grading system is as follows:

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S-1: Is the classification which indicates no significant impairment in the inmate's ability to adjust within an institutional environment due to the absence of an Axis I disorder, personality disorder, or mental retardation (MR). This classification may be assigned by a Psychological Specialist, Psychologist, Psychiatrist, Psychiatric Nurse, or in their absence, by a non-psychiatric physician.

S-2: Denotes mild impairment in adaptive functioning within general inmate

housing which is associated with an Axis I disorder, personality disorder, or MR (unless the inmate who suffers from mental retardation also has a diagnosed mental disorder which warrants a higher grade). The impairment is not so severe as to prevent satisfactory adjustment in general inmate housing with appropriate case management and brief psychological counseling. This classification may be assigned or reduced by a psychologist or psychiatrist, or in their absence, by a non-psychiatric physician. Note that in addition to S-2, the inmate with MR is also assigned the grade of “I-S” on the health profile. This latter grade indicates that the inmate is considered impaired (I) for mental health (S) reasons and is the sole means by which the MR inmate can be identified in the Offender Based Information System. MR is the only mental health related disorder or condition for which an inmate can be designated as impaired on the health profile.

S-3 Denotes moderate to severe impairment in adaptive functioning due to the

above-mentioned disorders. The impairment is not so severe as to prevent satisfactory adjustment in general inmate housing with case management, group and/or individual counseling, and psychiatric consultation. Clinical management of the disorder may require at least periodic administration of psychotropic medication, although the inmate may exercise his/her right to refuse the medication. An S-3 classification can only be assigned or reduced by a psychiatrist or senior psychologist.

S-4: This classification denotes assignment to a Transitional Care Unit (TCU) and

can only be assigned or changed by a psychiatrist at a TCU. A multidisciplinary team will tailor a treatment plan to the inmate's specific needs and limitations.

S-5: This classification denotes assignment to a Crisis Stabilization Unit (CSU)

or to the Corrections Mental Health Institution (CMHI), the long-term care psychiatric hospital operated by the Department. This classification can only be assigned or changed by a psychiatrist at a CSU or at CMHI. A multidisciplinary team will help the inmate recover from a psychiatric emergency situation, such as suicide attempt, psychotic break, or severe loss of behavioral control.

Only a psychiatrist or psychologist can approve an evaluation or re-evaluation of an inmate’s mental health grade, however, other mental health staff may recommend appropriate changes to the Chief Health Officer in their absence. Institutional capacities of mental health grades can be found in Attachment A, “Facilities List, Cluster Demographics and Functional Capacities”.

b) The mental health scope of services to be provided to the inmate population by appropriate mental health staff includes, but is not limited to: (1) Screening and orientation of all new arrivals.

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(2) Evaluation of each inmate housed in administrative or disciplinary confinement or protective/close management on or before the 30th consecutive day and every 90th day thereafter.

(3) Additional screening of each sex offender to determine need and amenability to treatment.

(4) Psychological evaluation at the request of the Parole Commission or institutional staff. (5) Case management for each S-2 and S-3 inmate and other inmates who require

treatment. Case management consists of various activities designed to facilitate medically necessary care and to monitor its impact.

(6) Psychiatric assessment of those inmates referred for possible pharmacological intervention.

(7) Routine psychiatric review of each S-3 inmate; to include review of adjustment to facility, medication efficacy, and medication review.

(8) Individualized Service Plans, regularly updated for each S-2 and S-3 inmate, and others receiving ongoing monitoring and/or care.

(9) Nursing staff will provide medication distribution, medication education for S-3 inmates as determined by each inmate’s service plan, routine assessment of medication side effects, and monitoring of medication compliance.

(10) Regular group and/or individual counseling for S-2 and S-3 inmates, and others in need of treatment.

(11) Crisis intervention and timely referral of inmates who require a higher level of care than what is available at the facility.

Additional contractual responsibilities will be:

(1) Ongoing training of other institutional staff on relevant mental health topics. (2) Supervision of non-doctoral psychological staff by a doctoral psychologist. (3) Thorough documentation of service delivery in the inmate’s medical record. (4) Maintenance of logs of workload and service delivery. (5) Updating various screens in the Health Service component of the Offender Based

Information System (OBIS-HS). (6) Participation in the Institutional Clinical Quality Management Program.

12. Dental Services

Within the first ninety (90) days of the start date of the Contract, the Department will assess the delivery of dental care in Region IV to determine the status of the overall dental care system. All Emergency/Urgent dental care issues will be addressed by the Department prior to the Contractor assuming responsibility for the healthcare at each institution. All dental care shall be provided in accordance with:

• Chapter 466, Florida Statutes • Standards referred to in Section II., A. Authority/Rules/Regulations and

Section II., D., 1. Standards. • American Correctional Association standards • American Dental Association standards • Florida Board of Dentistry Rules • Center For Disease Control Standards • Occupational Safety and Health Administration Standards

a) The Department’s guidelines for care are enumerated in HSB 15.04.13

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b) 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.

c) The Contractor shall provide emergency and comprehensive dental care, consistent with the standards outlined above. This includes reexamination, complete and partial dentures, crowns and bridges when indicated, operative, endodontics, periodontics and oral surgery. Prevention of dental diseases must be stressed along with oral hygiene education.

d) The Contractor shall have back-up coverage when the institutions’ dentists are not available.

e) All Contractor’s dentists will be licensed in the State of Florida and be in good standing with the Florida Board of Dentistry.

f) All dental prosthetics shall be provided by the Contractor through the PRIDE of Florida Dental Laboratory.

g) Clinical oversight of the Contractor’s dentists shall be provided by the Office of Health Services’ Director of Dentistry.

13. Pharmacy Services

a) All pharmacy-related duties shall be performed in strict compliance with applicable Florida Statutes, Florida Board of Pharmacy Rules, Federal Drug Enforcement Administration Rules, Department Policies and Procedures and the standards set forth in Section II., A. Authority/Rules/Regulations and Section II., D., 1. Standards above.

b) The Pharmacy shall be permitted to provide all pharmacy services for medication distribution at the institution as required by Chapters 465 and 893, Florida Statutes. This may be effected by utilizing on-site pharmacies, mail order pharmacies or any pharmacy process meeting the requirements in this section and the requirements of Section II., D., 1. Standards.

c) The Contractor shall provide coverage on-site or on-call by a licensed pharmacist 24 hours a day, 7 days a week. Each pharmacist performing services under the Contract shall be reachable by beeper.

d) The Contractor shall provide, furnish and supply pharmaceutical 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 and expiration date and any applicable warnings or dietary instructions.

e) The Contractor may provide liquid psychotropic medications in unit doses, individually labeled, with manufacturer, lot number, expiration date and date packaged listed. If the Contractor utilizes pill form psychotropic medications, the necessary precautions must be taken to prevent inmate “cheeking” or other means of retaining medications without ingestion.

f) The Contractor shall strictly comply with the Department’s formulary in all cases unless the Regional Medical Executive Director approves a medication exception request.

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g) The Contractor shall provide other medications in liquid unit dose properly labeled as specified by the CHO.

h) The Contractor shall provide injectable medications as required.

i) 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.

j) 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 can resume. The specific drugs and quantities shall be determined by the CHO in conjunction with the Pharmacy and Therapeutics Committee.

k) The Contractor shall provide emergency drugs in sealed emergency kit(s) as requested by the Chief Health Officer.

l) In accordance with HSBs 15.03.29 and 15.05.04, the Contractor shall provide and fill all prescriptions for inmates leaving on writ or discharge for a maximum of 30 days or in sufficient quantity to complete the current prescription. In no event shall an inmate on maintenance medications be released or sent without at least seven days supply of such medication. The medication should be provided to the transferring officer along with the transfer summary.

m) The Contractor shall properly package all medications in light and/or humidity resistant containers as appropriate.

n) The Contractor shall label each prescription container to include inmate name, inmate number, inmate location, date, medication name, strength, instructions, prescribing physician, quantity, pharmacist's initials, prescription number and warnings.

o) The Contractor shall package non-controlled, non-abusable medications in not more than a month's supply as allowed by the Chief Health Officer. If the quantity is larger than 120 tablets, the supply shall be dispensed not to exceed 120 tablets with appropriate refills.

p) The Contractor shall maintain copies of all prescriptions issued to inmates in a permanent file for a period of three (3) years. Copies will be provided to the Department upon request.

q) 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 Healthcare Contract Monitoring Team, the Warden and the Office of Health Services’ Director of Pharmacy or Designee.

r) The Contractor shall provide copies of records requested within 24 hours.

s) The Contractor shall document and maintain a medication administration record to include all information contained on the prescription label and the name of the practitioner who prescribed the medication.

t) The Contractor shall perform in-service training for staff according to a schedule mutually agreed upon and approved by the CHO.

u) The Contractor shall provide a licensed pharmacist to perform third party drug utilization reviews as requested by the Clinical Quality Management Committee.

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v) 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, the 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 Director of Pharmacy.

w) The Contractor shall provide a Pharmacist to serve as chairperson of the Institution Pharmacy and Therapeutics Committee and to consult on-site and by telephone with the CHO and staff as requested.

14. Laboratory Services

a) The Contractor will provide medically necessary and appropriate diagnostic laboratory procedures.

b) 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.

c) 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 arrangement. The most cost-effective process may be utilized subject to prior Office of Health Services’ approval. However, the subcontracted laboratory must 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.

d) Services shall include:

1) Laboratory supplies and required equipment (i.e., centrifuges). 2) Pick-up and delivery on a daily basis, or as needed Monday through Friday. 3) Printer installed at the institution, to provide test results (FACSIMILE NOT

ACCEPTABLE). 4) Immediate telephone contact with written reporting capability within 24 hours.

e) The Contractor will 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 shall include reordering of the lab tests.

15. Radiology Services

a) The Contractor shall provide medically necessary and appropriate diagnostic X-ray procedures.

b) 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 not, the Contractor may provide routine or non-urgent x-rays through the Department’s contracted provider or under a written subcontract arrangement

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with a provider approved in writing by the Department. The most cost-effective process may be utilized subject to the prior approval of the Office of Health Services. All services shall be provided in accordance with applicable state and local regulations for equipment and personnel licensure.

c) The Contractor shall provide all fluoroscopy, magnetic imaging, CAT scan, ultrasound and other special studies for all inmates.

d) 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 a reasonable time.

16. Disasters

a) Subject to the Warden’s approval, the Contractor shall develop procedures, within 120 days from the effective start-up date of the Contract, for the delivery of medical services in the event of a disaster such as fire, tornado, epidemic, riot, strike or mass arrests. This “Disaster Plan” shall be developed and/or instituted by the CHO working closely with the Warden’s designated Assistant Warden. The plan shall include, but not be limited to:

1) Establishment of communications system; 2) Recall of key staff ; 3) Assignment of healthcare staff ; 4) Establishment of command post ; 5) Safety and security of the patient and staff areas ; 6) Use of emergency equipment and supplies ; 7) Establishment of a triage area ; 8) Triage procedures ; 9) Medical records - identification of injured ; 10) Use of ambulance services ; 11) Transfer of injured to local hospitals ; 12) Evacuation procedures (to be coordinated with security personnel); and 13) Practice drills which shall be conducted annually.

b) In addition, the Contractor shall provide a Familiarization Staff Training Program within one hundred twenty (120) days from the effective date of the Contract for all healthcare employees in case of an institutional emergency, including riots, hostage events and escapes. Emergencies shall be handled in the following manner:

1) All in-house measures for dealing with the emergency shall be taken. 2) The Disaster Plan as discussed above shall be put into effect. 3) 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.

17. Inmate Health Education

The Contractor shall develop, subject to Department approval, an inmate health education program. To promote this 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:

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a) Personal hygiene; b) Nutrition ; c) Physical fitness ; d) Stress management ; e) Sexually transmitted diseases ; f) Chemical dependency ; g) Tuberculosis and other communicable diseases ; h) Effects of smoking; i) HIV/AIDS ; j) Hypertension/Cardiac; k) Epilepsy ; l) Diabetes ; m) Dermatology; and n) Rehabilitation.

18. Quality Management

In order to ensure compliance with the Office of Health Services’ Clinical Quality Management Program, the Contractor shall establish and maintain an Institutional Clinical Quality Management program that maintains full compliance with the following Health Services Bulletins:

a) HSB 15.09.01 - Quality Management b) HSB 15.09.02 - Infection Reporting to the Department of Health c) HSB 15.09.03 - Infection Control Program d) HSB 15.09.06 - Medical Peer Review Committees e) HSB 15.09.08 - Clinical Risk Management Program f) HSB 15.09.09 - Mortality Review Program The Contractor will also maintain full compliance with the policies and procedures pertaining to quality assurance and quality indicators, which are currently being revised by the Office of Health Services.

19. 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 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 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. a) Performance Measures

Pursuant to the Government Performance and Accountability Act of 1994, certain performance outcome measures are established in the General Appropriations Act FY 2000 – 2001 to protect the public and maintain a humane environment in correctional institutions for incarcerated offenders and the staff that maintains custody of them by applying effective basic healthcare treatment to inmates. The Contractor will ensure that compliance/performance rates for the following two outcome measures are at or below those set in the General Appropriations Act FY 2000 – 2001 or Implementing Bill.

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1) Percentage of healthcare grievances upheld region-wide. 2) Number of suicides region-wide per 100,000 inmates compared to the national

average for correctional facilities/institutions.

Due to the fact that a high number of healthcare grievances upheld imply a weakness in the institutional healthcare delivery system, exceeding the healthcare grievance rate established in the General Appropriations Act FY 2000 – 2001 or Implementing Bill may result in the assessment of liquidated damages as set forth in Section VII., W., Liquidated Damages. Exceeding either rate will result in appropriate clinical reviews by the Office of Health Services and possible citations for contract non-compliance.

b) Inmate Transfers All inmate transfers shall be screened, evaluated, and documented, as required by the applicable standard, by medical personnel immediately prior to transfers or upon arrival at the receiving facility. The preliminary screening shall include:

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.

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.

c) Explanation of procedures for access to health and dental services shall be provided to inmates both orally and in writing via the inmate handbook. The handbook will be provided by the Department.

d) Medical classification of inmates. The findings of the preliminary screening and evaluation shall be recorded on a Department approved screening form and entered into the inmate's medical record.

e) The Department will provide a report to the Contractor (as an informal communication), regarding any inmates considered by the receiving institution to be inappropriately transferred by reason of medical condition. A copy of this report shall be forwarded to the Office of Health Services, to the attention of the Contract Manager. The Contractor will investigate and reply in accordance with the contract communications procedure.

20. Communications

a) Contract communications will be in three forms: routine, informal and formal. For the purposes of this Contract, the following definitions shall apply:

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1) Routine - All normal written communications generated by either party relating to performance of the scope of services. Routine communications must be acknowledged or answered within 30 calendar days of receipt.

2) Informal - Special written communications deemed necessary based upon either

contract compliance or quality of service issues. Must be acknowledged or responded to within 15 calendar days of receipt.

3) 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 7 seven days of receipt.

b) The Contractor shall respond to Informal and Formal communications by facsimile, with follow-up by hard copy mail.

c) The only personnel authorized to use formal contract communications are the Department's Contract Manager, Healthcare Contract Monitoring Team, the Contractor’s President or Designee and the Deputy Director of Health Services' Administration. 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.

d) With informal contract communications, the same date/time numbering system shall be implemented and the same response time frame is in effect.

e) In addition to the personnel named under formal contract communications, personnel authorized to use informal contract communications are the Warden, Regional Medical Executive Director, Regional Health Services Manager, Contract Administrator and any comparable corporate positions or other persons designated in writing by the Contractor.

f) 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 shall 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 the necessary 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. The Healthcare Contract Monitoring Team shall be copied on all such correspondence.

21. Meetings

Contract meetings may be scheduled at the request of the Department or the Contractor. Depending upon the subject matter, participants may be the Healthcare Contract Monitoring Team, the Contractor's Contract Supervisor or Manager, the Department's Contract Manager, the Contractor's Corporate Officers or appropriate Designees, the Director of Health Services’ Administration and other representatives as requested. Agendas will be agreed upon prior to the meeting.

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22. Clinical Surveys and Contract Monitoring

Each institution shall be subject to comprehensive surveys by:

a) The Correctional Medical Authority (CMA) in regards to dental, physical, and mental healthcare, no less than triennially.

b) The Healthcare Contract Monitoring Team as required by the Contract Manager, but no less than annually. Monitoring shall be conducted for the purposes of determining whether the Contractor is “compliant” or “non-compliant” with the service requirements of the Contract and shall consist of, but not be limited to, reviews of the following:

1) Service requirements of the Contract; 2) Administrative issues, including fiscal reconciliation; 3) Facilities; 4) Contractor staff; 5) Clinical operations review; 6) Interviews with Department and program staff; and 7) Interviews with inmates.

c) Office of Health Services and the Department’s Internal Audit Section, which may conduct clinical quality reviews and contract compliance reviews.

d) The Office of the Inspector General which may conduct Inspector General Management Reviews.

Any non-compliance issues resulting from surveys, reviews or monitoring will be summarized in writing and provided to the Contractor in accordance with Section II., D., 20. Communications. Failure to meet contract compliance or service requirements may result in the assessment of liquidated damages as set forth in Section VII., W., Liquidated Damages.

23. Liquidated Damages

By execution of this Contract, the Contractor expressly agrees to the imposition of liquidated damages, in addition to all other remedies available to the Department by law, as outlined in Section VII., W., Liquidated Damages. The Contractor shall forward a cashier’s check or money order, payable to the Department in the appropriate amount to the Contract Manager within ten (10) days of receipt of a written notice of demand for liquidated damages due.

III. COMPENSATION

A. Payment

The Department will compensate the Contractor for the provision of comprehensive healthcare delivery services that meet the requirements of this Contract as specified in Section II, Scope of Work. Payment will be made monthly at the per diem rate 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. Payment for each facility shall begin at 12:01 a.m. on the implementation date as indicated in Section II., C., Implementation Plan or the actual date of implementation in the event of delay.

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Per Diem (Per Inmate Per Day) Contract Year

East Cluster West Cluster Year 1 $12.92 $7.30

Year 2 $13.31 $7.52

Year 3 $13.71 $7.75

Year 4 $14.12 $7.98

Year 5 $14.54 $8.22

Optional Renewal Period

Year 1 $14.98 $8.47

Year 2 $15.43 $8.72

Year 3 $15.89 $8.98

Year 4 $16.37 $9.25

Year 5 $16.86 $9.53 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 last payment of the Contract will be withheld until all pending adjustments have been determined and reconciled.

B. Electronic Transfer of Funds

Contractors that wish to receive payment through an electronic transfer of funds, must contact the Department of Banking and Finance to set up account information. Please contact the Department of Banking and Finance, Bureau of Accounting, ETF Section, Jack Peterson (850-410-9434) or Steve Smith (850-410-9372).

C. Submission of Invoice(s)

The Contractor agrees to submit a single monthly summary invoice within fifteen (15) days following the end of the month for which payment is being requested for compensation for services in detail sufficient for a proper pre-audit and post-audit thereof and shall follow the format outlined in Attachment B – Sample Invoice Format. The payment shall be calculated by multiplying the ADP for each institution by the current per diem rate times the number of days in the month. The Contractor shall submit invoices pertaining to this Contract to: John G. Burke, Deputy Director of Health Services Office of Health Services Florida Department of Corrections 2601 Blair Stone Road Tallahassee, Florida 32399-2500

(850) 487-4703

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D. Official Payee

The name and address of the official payee to whom payment shall be made is as follows: Wexford Health Sources, Inc. 381 Mansfield Avenue, Suite 205 Pittsburgh, PA 15220 412-937-8590 (telephone)

E. Travel Expenses

The Department shall not be responsible for the payment of any travel expense for the Contractor that occurs as a result of this Contract.

F. 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.

G. 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.

H. 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.

I. 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 Banking and Finance. 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.

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J. 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 by the Department or the end date of this Contract, whichever occurs last. 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 due under the terms of the Contract may be withheld until all applicable deliverables and invoices have been accepted and approved by the Department.

K. Vendor Ombudsman

A Vendor Ombudsman has been established within the Department of Banking and Finance. 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 State Comptroller’s Toll Free Hotline.

IV. CONTRACT MANAGEMENT

A. Department’s Contract Manager

The Contract Manager for this Contract will be: John G. Burke, Deputy Director of Health Services Office of Health Services Florida Department of Corrections 2601 Blair Stone Road Tallahassee, Florida 32399-2500 (850) 487-4703 [email protected] The Contract Manager or his designee will perform the following functions:

1. serve as the liaison between the Department and the Contractor;

2. direct the Contract Administrator to process all amendments, renewals, and termination of this Contract;

3. review, verify, and approve invoices for services from the Contractor; and

4. review, verify and take the appropriate action on reports from the Contract Monitoring Team.

B. Department’s Healthcare Contract Monitoring Team

The Healthcare Contract Monitoring Team will perform the following functions:

1. monitor the Contractor’s progress on an on-going basis;

2. evaluate the Contractor’s performance on an on-going basis;

3. 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:

4. conduct special reviews as directed by the Contract Manager; and

5. report all findings to the Contract Manager with a copy to the Contract Administrator.

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C. Department’s Contract Administrator

The Contract Administrator for this Contract will be:

Lisa M. Bassett, Chief Bureau of Purchasing Department of Corrections 2601 Blair Stone Road Tallahassee, Florida 32399-2500 850/488-6671 (telephone) 850/922-5330 (facsimile number) [email protected] The Contract Administrator will perform the following functions:

1. maintain the Contract file;

2. process all Contract amendments, renewals, and termination of the Contract; and

3. maintain the official records of all correspondence between the Department and the Contractor. D. Contractor’s Representative

The name, title, address, and telephone number of the Contractor’s representative responsible for administration and performance under this Contract is: Copy: T. R. Sucher, III Fred W. Schwartz Executive Vice President for Operations Executive Vice President & Chief Financial Officer Wexford Health Sources, Inc. Wexford Health Sources, Inc. 205 Greentree Commons 205 Greentree Commons 381 Mansfield Avenue 381 Mansfield Avenue Pittsburgh, PA 15220 Pittsburgh, PA 15220 412-937-8590 (telephone) 412-937-8590 (telephone) 412-937-8599 (facsimile) 412-937-8599 (facsimile) [email protected] [email protected]

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

This section establishes the only procedures by which the Contractor may obtain compensation or reimbursement in excess of the amounts proposed for performance of this Contract or by which the Department may reduce contract costs or prices or the scope of work/scope of service. During the term of this Contract, policies, regulations and laws may change. In addition, the Department may request changes in the scope of service for operational or administrative reasons. These changes may impact Contractor’s service delivery in terms of materially increasing or decreasing the Contractor’s cost of providing healthcare services. While the Department recognizes that changes may occur, there is no way to anticipate what those changes will be nor is there any way to anticipate the related costs associated with the changes. All requests for changes shall be in writing and shall be handled as a formal communication. The Contractor and the Department may agree to negotiate in advance for additional compensation to cover substantial cost increases associated with any changes in the scope of service required to ensure continued compliance with State or Federal laws, statutes or regulations, or Department policy or

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regulations. Conversely, the parties agree to negotiate a reduction in compensation should resulting changes in the scope of services result in a substantial reduction of costs. In the event the scope of services changes, either substantially increasing or decreasing the Contractor’s costs, the contract will be amended in writing to address the change and reasonable compensation will therefore be paid. It is specifically agreed that any compensation will be effective the date the changed scope of services is directed, in writing, and implemented. Full, written justification with documentation sufficient for audit will be required to authorize an increase or decrease in compensation. In the event a change of scope occurs, either party shall have ninety (90) days to request an increase or decrease in compensation or that party will be considered to have waived this right. If the parties are unable to negotiate an agreed upon increase or decrease in compensation or reimbursement, the Director of Health Services shall determine what changes to the scope of services will be made and what the resultant 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 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 Chapter

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119, 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 annual 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. 3. Retention of Records

The Contractor agrees to retain all client records, financial records, supporting documents, statistical records, and any other documents (including electronic storage media) pertaining to this Contract for a period of seven (7) years. 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. All documents must be retained by the Contractor at the address listed in Section IV., C., Contractor’s Representative or the address listed in Section III., C., Official Payee, for the duration of this Contract. 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 the 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 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. Prison Rehabilitative Industries and Diversified Enterprises, Inc. (“PRIDE”)

The Contractor agrees that any articles which are the subject of, or are required to carry out this Contract, shall be purchased from PRIDE, identified under Chapter 946, Florida Statutes, in the same manner and under the procedures set forth in Subsections 946.515(2) and (4), Florida Statutes. The Contractor shall be deemed to be substituted for the Department in dealing with PRIDE, for the purposes of this Contract. This clause is not applicable to subcontractors, unless otherwise required by law. Available products, pricing, and delivery schedules may be obtained by contacting PRIDE.

C. Procurement of Materials with Recycled Content

It is expressly understood and agreed that any products or materials which are the subject of, or are required to carry out, this Contract shall be procured in accordance with the provisions of Section 403.7065 and Section 287.045, Florida Statutes.

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D. 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 Wexford Health Sources, 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.

E. Employment of Department Personnel

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.

F. 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.

G. 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.

H. Indemnification

NOTE: This section is not applicable to contracts executed between state agencies or subdivisions, as defined in Section 768.28, Florida Statutes. 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 §1983, the Civil Rights Act.

I. Contractor’s Insurance

The Contractor agrees to provide adequate insurance coverage on a comprehensive basis and to hold such insurance at all times during the existence of this Contract. The Contractor accepts full responsibility for identifying and determining the type(s) and extent of insurance necessary to provide reasonable financial protection for the Contractor and the Department under this Contract. Upon the execution of this Contract, the Contractor shall furnish the Department written verification of 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.

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J. Independent Contractor Status

The Contractor shall be considered an independent contractor in the performance of its duties and responsibilities under this Contract. 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 a joint venture between the parties.

K. 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. The Director of Health Services shall decide the dispute, reduce the decision to writing, and deliver a copy to the Contractor, the Contract Manager, Healthcare Contract Monitoring Team and the Contract Administrator.

L. 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 the 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.

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.

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M. 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 the Contract. No subcontract, which the Contractor enters into with respect to performance of any of its functions under the 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. 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 will result in a penalty to be paid by the Contractor to the subcontractor in the amount of one-half (½) 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. Pursuant to Chapter 287.0585(2), F.S., the immediately preceding paragraph shall not apply when the contract between the Contractor and subcontractors or subvendors provides otherwise.

N. 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.

O. 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.

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 IV., Contract Management, of this Contract shall be

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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. Public Entity Crimes Information Statement

A person or affiliate who has been placed on the Convicted Contractor 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 Contractor List.

V. Discriminatory Vendors List

An entity or affiliate who has been placed on the Discriminatory Vendor List may not submit a bid or proposal to provide goods or services to a public entity, may not submit a bid or proposal with a public entity for the construction or repair of a public building or public work, may not submit bids or proposals on leases of real property to a public entity, may not perform work as a contractor, supplier, subcontractor or consultant under contract with any public entity and may not transact business with any public entity.

W. Liquidated Damages

By execution of this Contract, the Contractor expressly agrees to the imposition of the following liquidated damages, in addition to all other remedies available to the Department by law, as outlined in the Department’s Request for Proposal #00-DC-7342, Section 7.30. The Contractor shall forward a cashier’s check or money order, payable to the Department in the appropriate amount to the Contract Manager within ten (10) days of receipt of a written notice of demand for liquidated damages due.

1. If the Contractor fails to meet contract compliance or service requirements or correct contract

deficiencies, the Deputy Director of Health Services Administration shall determine if liquidated damages are to be assessed. Notice of the unsatisfactory service and of the Department’s intent to assess liquidated damages shall be made in writing to the Contractor. Damages will be assessed as follows:

Contract #C1938


a) Within the first ninety (90) days after the implementation date for each facility, no

damages will apply. b) Ninety days after the implementation date at each facility: Within the first fifteen

(15) days after the Contractor’s receipt of notice – No adjustment for damages if deficiencies are corrected within the fifteen (15) day time period.

c) After fifteen (15) days of initial notice of unsatisfactory service (without corrective action initiated and if unsatisfactory service continues), liquidated damages in the amount of $1,000 per day will be assessed.

2. 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 re-obtainment of accreditation must be reestablished as soon as possible. Liquidated damages shall be assessed per institution and per incident of loss of accreditation. The Contractor shall not be assessed these liquidated damages unless the Contractor has assumed responsibility for the delivery of comprehensive healthcare services for at least nine months at the institution.

3. Pursuant to Section II., D., 19., a. Performance Measures, if the percentage of inmate

healthcare grievances appealed to and upheld by the Office of Health Services exceeds the performance standard of 3% set forth in the General Appropriations Act FY 2000 - 2001, liquidated damages in the amount of $5,000 will be assessed for each percentage point above the 3% standard. This will apply to each contract year with the first such period ending June 30, 2002.

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 Leon County, Florida.

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, RFP #00-DC-7342 and the Contractor’s response to the RFP, contain all the terms and conditions agreed upon by the parties. Should there be any conflict in language, this Contract will govern, followed by the Department’s Request for Proposal #00-DC-7342 and then the Contractor’s proposal.

THIS SPACE LEFT INTENTIONALLY BLANK

Contract #C1938


IN WITNESS THEREOF, the parties hereto have caused this Contract to be executed by their undersigned officials as duly authorized. CONTRACTOR: STATE OF FLORIDA DEPARTMENT OF CORRECTIONS SIGNED BY:

SIGNED BY:

NAME:

Kevin C. Halloran NAME:

Michael W. Moore TITLE: President & Chief Executive Officer TITLE: Secretary Department of Corrections DATE: DATE: FEID #: 59-2363973 APPROVED AS TO FORM AND LEGALITY SUBJECT TO EXECUTION BY THE PARTIES

Louis A. Vargas

General Counsel Department of Corrections

Contract #C1938 Attachment A


Facilities List, Cluster Demographics and Functional Capacities East Cluster

CAPACITIES SPECIALTIES/FUNCTIONAL CATEGORIES

DC # Institution Male/ Female

Maximum Institutional

Capacity

Maximum Facility

Capacity


Date

Average Daily


CapacityCSU


475 Broward F 674 674 2 39 14 400 64 54 419 Dade Main F 2,057 668 6 6 6 300 72 77 463 Dade Annex M 1,325 400 241 217 426 Big Pine Key R.P. M 64 401 Everglades M 1,805 1,805 112 112 110 400 307 276

406 Glades M 1,447 918 142 July-2004 145 ---

462 Glades WC M 287 431 Loxahatchee R.P. M 92 469 West Palm Beach WRC M 150

418 Indian River M 486 486 149 Nov-2001 --- ---

430 Martin M 1,648 1,300 129 Oct-2003 224 86 130 166 200 208 187

420 Martin WC M 264 444 Fort Pierce WRC M 84

402 SFRC M 2,036 1,317 879 Jan-2004 20 47 150

446 Hollywood WRC M 84 452 Atlantic WRC M 45 457 Miami North WRC M 191 459 Miami WRC M 37 465 Pomp Beach WRC M 212 473 Opa Locka WRC M 150

TOTALS 10,153 0 22 342 204 246 166 39 61 1,850 1,037 811

Contract #C1938 Attachment A


West Cluster CAPACITIES SPECIALTIES/FUNCTIONAL CATEGORIES

DC # Institution Male/ Female Maximum

Institutional Capacity

Maximum Facility

Capacity


Date

Average Daily


CapacityCSU


510 Charlotte M 1,410 1,290 112 112 111 48 52 500 206 185 544 Ft. Myers WC M 120

560 Desoto Annex

M

1,711 1,327

223 Sept-2002

223 Jan-2003

564 DeSoto WC M 288 241 525 Arcadia R.P. M 96 501 Hardee M 1,724 1,436 112 84 56 563 Hardee WC M 288

576 Hendry M

1,573 1,225

561 Hendry WC M 280 527 Copeland R.P. M 68

404 Okeechobee M 1,378 1,378 263 Dec-2001 132 86 172

TOTALS 7,796 7,796 0 356 282 339 0 48 52 500 447 185

Notes: 1) RP = Road Prison, WC = Work Camp, WRC = Work Release Center 2) HIV capacity is a sub-total of the Medical Grade (X) capacity

3) The proposed expansion of SFRC is tentative

SAMPLE MONTHLY SUMMARY INVOICE Contract #C1938 Attachment B


Vendor Name

Address 1 Electronic Funds Transfer ID:

Address 2 Organization Code (11)*:

City, State, ZIP Code Expansion Option(2)*:

Object Code (6)*:

INSTITUTION BY CLUSTER PER DIEM ADP DAYS IN MONTH MONTHLY TOTAL

EAST CLUSTER

Broward Correctional Institution X X =

Dade Correctional Institution X X =

Everglades Correctional Institution X X =

Glades Correctional Institution X X =

Indian River Correctional Institution X X =

Martin Correctional Institution X X =

South Florida Reception Center X X =

WEST CLUSTER

Charlotte Correctional Institution X X =

DeSoto Correctional Institution X X =

Hardee Correctional Institution X X =

Hendry Correctional Institution X X =

Okeechobee Correctional Institution X X =

TOTAL MONTLY COST $

Submitted By: Date:

Verified/Approved By*: Date:

*Department fields only

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