The California Department of Corrections and Rehabilitation (CDCR), California Correctional Health Care Services (CCHCS) may have a requirement for a Correctional Health Care Provider Network (CHCPN).

The following information is sourced from the Request for Information (RFI) document and is subject to change upon the release of a formal solicitation.

PURPOSE

The California Department of Corrections and Rehabilitation, California Correctional Health Care Services (CDCR/CCHCS), invites interested parties to provide information for a Health Care Provider Network of community-based specialty medical services providers and a Third-Party Administrator for healthcare claims processing services for CDCR/CCHCS. This RFI is issued solely for information and planning purposes.

This RFI shall not be construed in any manner to create an obligation on the part of CDCR/CCHCS to enter any contract or serve as a basis for any claim whatsoever for reimbursement of costs for efforts expended.

Furthermore, the scope of this RFI may be revised at the option of CDCR/CCHCS at any time, or this RFI may be withdrawn or canceled by CDCR/CCHCS at any time.

Notwithstanding any other provision of this RFI, Participants are hereby specifically advised that this RFI is an informal solicitation of information only and is not intended to be, nor is it to be construed as, engaging in formal competitive bidding pursuant to any statute, code, ordinance, rule, or regulation. Therefore, CDCR/CCHCS shall not be obligated by any responses received by CDCR/CCHCS or by any statements or representations, whether oral or written, that may be made by CDCR/CCHCS, and CDCR/CCHCS reserves the right to reject any or all information submitted hereunder for any reason whatsoever. CDCR/CCHCS shall be held free from any liability resulting from the use or implied use of the information submitted in any response to this RFI. Submission of response shall constitute the Participant’s acknowledgment of this notice and the Participant’s acceptance of this disclaimer. B.

BACKGROUND

CDCR is currently responsible for health care services to approximately 90,000 incarcerated persons in thirty-one (31) CDCR institutions (refer to Attachments B and C) and thirteen (13) Reentry Programs (REPS) facilities (refer to Attachments D and E) throughout the state. The scope of the health care mission includes primary, urgent, acute, emergency, and long-term care, as well as preventative care and chronic care management. Cases requiring specialty medical consultation, treatment, or complex specialty management are seen remotely by telemedicine or referred to community-based medical service providers.

In 2014, CCHCS contracted with a Health Care Provider Network (HCPN) to develop and implement a network of community-based healthcare providers to provide services to incarcerated persons within CDCR and REPS that are not available in the CDCR institutions or REPS facilities. The network consists of hospitals, onsite and offsite specialty care, and a full scope of ancillary services.

The following information is sourced from the Request for Information (RFI) document and is subject to change upon the release of a formal solicitation.

SCOPE OF WORK AND REQUIREMENTS

CCHCS is requesting information from qualified contractors that can provide a HCPN to our patient population. The organization will enter into contracts with sufficient numbers, types and geographic locations of participating Providers to ensure that all covered services will be available and accessible to CDCR and REPS incarcerated persons, in accordance with CCHCS’ requirements. It will establish and expand the number of cost-effective provider contracts within the statewide HCPN for off-site and on-site health care to CDCR and REPS patients. The network must also include provider services in Oregon, Nevada, and Arizona for nearby CDCR institutions or facilities. The organization must contract with select hospitals, physicians, and other Providers identified by CCHCS if the Provider meets organization’s network standard and pricing guidelines. The HCPN shall include, but is not limited to, the services found in Attachment A – Scope of Services and Attachment A-1 – Prior Authorization. The organization will be required to interface or data share with both CCHCS and a Third-Party Administrator for claims administration.

Scope of Services

1. The Contractor shall have the following services included in the network:
   1. Hospital Services
      Facility Services, Equipment, Personnel or other resources necessary to provide the service accordingly to generally accepted standards of hospital practice for inpatient, outpatient and Emergency Care Services.
      • Medical, Nursing, Surgical, Pharmaceutical and Dietary Services; basic medical supplies and basic diagnostic services, such as laboratory, radiological and X-Ray
      • Surgical procedures requiring overnight observation and treatments
      • Surgical procedures not requiring overnight observations and treatments
      • Full twenty-four (24) hour access to emergency services
      • Full twenty-four (24) hour access to Bed and Board
      • Tertiary/Bone Marrow and Solid Organ Transplant Services
      • Intensive Care and Related Services
      • Telemetry, Sub acute Services, and Acute Rehabilitation Services
      • Follow up appointments with Specialty Care Service Providers
      • Diagnostic and Imaging Services for Computed Tomography (CT), Magnetic resonance imaging (MRI), Ultrasound, Mammography, Neurological specialty in CT and MRI
      • Mental Health Treatment (Emergency Care Services)
      • Off-site Sleep Apnea Diagnostic Evaluation and Testing
      • Mental Health Treatment for Non-Emergency Care Services
   2. Specialists/Physician Services
      • Emergency Services
      • Inpatient/Outpatient Medical Service Consultation and Treatment
      • Surgery Inpatient/Outpatient Consultation and Treatment
      • Surgery Center Inpatient Medical Treatment
      • Office Medical Services and Consultations
      • Telemedicine Services – Synchronous and Asynchronous
      • Institution On-site Specialty Physician Medical Services and Clinical Services at institutions/facilities
      • Institution On-site Mobile Endoscopy and Colonoscopy Services
      • Low vision including medically necessary specialty lenses (e.g. Keratoconus)
      • Gender assignment surgery evaluations and procedures
      • Bariatric Services
   3. Ambulatory Surgery Centers and Specialty Service Centers
   4. Medical Transportation Services – Emergency/Non-Emergency
      • Emergency and Non-Emergency Air and Ground Ambulance Transports
      • Basic Life Support
      • Advanced Life Support
      • Other medically necessary transportation services including long-distance transports.
   5. Dental Specialty Services
      • Oral Surgeon Services
      • Maxillofacial
      • Periodontal
   6. Mental Health Services
      • Providers of acute community hospitals must have the availability of mental health services when the attending physician team indicates it is clinically necessary.
      • Inpatient Acute Psychiatric Hospital Services
        • Medical, Nursing, Pharmaceutical and Dietary Services;
        • Full twenty-four (24) hour access to Bed and Board;
        • Diagnostic and Therapeutic Services as required;
        • Basic medical supplies;
        • Basic diagnostic services, such as laboratory, radiological and XRay;
        • Mental Health Treatment (Emergency Care Services – which means medically necessary crisis intervention for situational crisis or acute episodes of mental illness); and
        • Mental Health Treatment for Non-Emergency Care Services when treating team determines services are needed.
      • Psychiatrist(s) and hospital(s) to evaluate CDCR patient(s) and/or perform Electro Convulsive Therapy, as needed. Services must be provided upon request.
   7. Medical Imaging Services
      • Off-site Medical Imaging Services
        • Including technical and professional component as designated in each section for general diagnostic procedures such as X-Rays, fluoroscopy, Ultrasound, Mammography, CT, MRI, Positron Emission Tomography (PET), and any other radiology services, etc.
      • Off-site Radiology Services
        • Physician interpreting off-site CDCR patient medical imaging exams shall provide professional and technical components for general Xrays, fluoroscopy procedures, diagnostic/breast Ultrasound, and diagnostic/biopsy Mammography, CT, MRI, and PET.
      • On-site Medical Imaging/Mobile Imaging Services
        • Services shall include technical and professional component as designated in each section for general diagnostic procedures such as X-Rays, fluoroscopy, Ultrasound, Mammography, CT, MRI, PET, radiologic procedures, etc.
        • Mobile echocardiography services performed by a qualified technician and qualified physician interpreters.
      • Imaging Read and Interprets
        • Radiologist(s) to interpret medical imaging exams
      • Radiology Supervisor/Operator Services
   8. Clinical Laboratory Services
      • STAT and Routine Testing:
      • Courier services
      • Electronic Lab Reporting System/Laboratory Information System
   9. Pathology Services
   10. Telemedicine Services – Synchronous
   11. Telemedicine Services – Asynchronous
       • eConsult
       • Store and Forward
   12. Onsite and Offsite Medicated Assisted Treatment (MAT) Services
   13. Reentry Program Contractor shall provide primary care services in the community for patients from the MCRP and the CCTRP, collectively known as REPS. Services shall include:
       • Physician Services (Primary Care)
       • Optometry Services
       • Dental Services
   14. Centers of Excellence (Centers of Excellence are defined as those centers for which there are specific credentialing criteria for the facility and physicians), to perform highly specialized, high-cost procedures such as transplants, burns, cancer treatment, and coronary artery bypass grafts, etc.
2. Provider Network Directory
   1. Customizable web-based portal, or
   2. Provider data file
3. Credentialing and Privileging of Providers

Prior Authorization

1. The Contractor is responsible to furnish all necessary personnel, materials, facilities, and other services (unless otherwise specified) to accomplish delivery of the Services described in this exhibit. The Contractor shall be able to perform the tasks associated with providing the above services and assume full responsibility for the provision of these services. Any and all services performed outside the scope of this Exhibit will be at the sole risk and expense of the Contractor.
2. Electronic Prior Authorization System
   • Web Portal
   • Reporting capabilities by institution, CDCR patient-inmate, requesting / referring physician, etc.
   • Prior Authorization and claims matching
   • Utilization Management collaboration
   • Case Management Guidelines
   • Change Management Services
   • Implementation and Development of system
   • Customization Capabilities