Medical and Pharmacy Services

The Vendor is required to provide for medical and pharmacy services include:
• On-site medical services to meet the medical needs of inmates (initial physical assessments, ongoing evaluation and treatment of medical conditions, stabilization of urgent and emergency medical/psychiatric conditions, and medication management);
• On-site specialty providers, such as optometry, podiatry, physical and occupational therapy, OB/GYN, and ENT;
• On-site dental services to meet the needs of inmates (initial assessment, extractions, examinations, and emergency treatment);
• On-site mental health care delivery to meet the needs of the inmates; and
• Telehealth services (example: hemodialysis) to enhance access to quality healthcare while maintaining the safety, security and privacy of offenders, and to bridge gaps by providing remote consultations with healthcare professionals.
- Establish a utilization management program for the review and analysis of onsite medical services and off-site referrals to preferred providers, including sub-specialty and inpatient stays.
- This shall include all on-site telehealth and specialty visits completed in the clinic and any hemodialysis.
- The program must include, at a minimum, non-urgent hospitalization precertification, urgent hospital certification, concurrent review, and prospective denial, discharge planning and prior authorization of targeted procedures.
- The utilization management program must demonstrate that the use of off-site services has been appropriate and that the length of stay, if applicable, is neither longer nor shorter than medically indicated.
- Negotiate the best rates for hospital and off-site medical care without compromising professional qualifications of providers or quality of services.
- Develop protocols and procedures to ensure ability to perform emergency medical services and to minimize disruption to provision of medical services during emergency conditions, such as a weather-related incident, fire, riot, rebellion, war, terrorism or threat of terrorism, disease or medical epidemics or outbreaks, and disruptions to supply chains.
- All medical services will be carried out in accordance with the applicable standard of care required of each practitioner in their respective fields in the Commonwealth and any applicable constitutional standard of care.
- Techniques and treatment protocols included in this program shall include, but not be limited to, management of the following most prevalent medical conditions or diagnoses:
• Minor lacerations, bruises (suturing, administration of Tetanus Toxic, etc.)
• Respiratory and chest pain
• Alteration of consciousness
• Trauma injuries
• Asthma
• Abdominal pain/disorders
• Cellulitis (infection of the skin)
• Joint pains
• Diabetes and complications
• Myocardial infarctions (heart attacks, cardio-pulmonary diseases)
• Varicose ulcers (lesions on the lower extremities secondary to complications of diabetes and other circulatory problems)
• Menstrual disorders
• Pregnancy
• Human immunodeficiency virus (HIV) and related illnesses
• Syphilis
• Chronic Kidney Failure (ERSD)
• Acute Kidney Injury (AKI)
• Toxic poisoning
• Venous insufficiency (blood vessel disorder)
• Hypertension
• Drug psychoses
• Drug and alcohol detoxification and symptoms
• Tuberculosis
• COVID symptoms
• Pandemic flu
• Methicillin-resistant staphylococcus aureus (MRSA)
• Epilepsy
• Cirrhosis and liver disease
• Hepatitis
• Removal of stitches/sutures and casts
• Diagnosis and identification of cancer for possible further treatment referral
• Any treatable disorder that may be feasibly identified pursuant to the applicable standard of care.