Medical Contract Monitoring Services

The Vendor is required to provide medical contract monitoring services for include:
• To ensure the medical contractor is providing all clinically necessary medical/dental/psychiatric services to all inmates, principally on-site as effectively and efficiently as possible.
• To ensure the medical contractor is maintaining all healthcare standards established by the board of local and regional jails (BLRJ) and the national commission on correctional healthcare (NCCHC).
• To ensure the medical contractor is maintaining proper levels of professional, nursing and other staff on-site for each shift at agency, and fulfilling and complying with all contractual obligations of the agreement.
• No less than one (1) on-site visit per month to attend the medical advisory committee (mac) and continuous quality improvement (CQI) meetings, and to perform an operational compliance audit with several of the following criteria.
• Regular communications, to include conversations, emails, and monthly written reports to the superintendent or his designee detailing the medical contractor’s general performance in accordance with their contract, and identifying areas of concern requiring greater attention.
• Ongoing compliance review with all NCCHC, and BLRJ accreditation standards related to inmate healthcare, including a mock audit to be performed prior to each triennial accreditation audit.
• The mock audit shall target standard requirements, applicable policy and procedures, actual practices observed and appropriate documentation review.
• Monthly audits of utilization review of outside hospitalizations, emergency room visits and specialty care as reported by the medical contractor.
• Outside services should be limited to the greatest extent possible with every effort being made to provide services on-site.
• Appropriate recommendations and actions shall be made monthly wherever it is determined that services were over utilized or could be handled differently.
• All outside care to per-diem inmates to ensure proper authorization has been obtained and that any services rendered are reimbursable by the appropriate agency.
• Inmate grievance logs to monitor patterns or trends of inmate complaints and potential litigation.
• The auditor shall review all grievances and medical contractor written responses, and randomly re-investigate certain grievances to confirm appropriate response by the medical contractor.
• All staff incidents involving medication errors and other related incidents, looking for trends and potential litigation.