Amendment #: '1
Contractor Vendor No: I~_2J~()

Contract #: lQ962
bMncy-of H~l11aJl Services/Departmentof Corrections
':ontractor:
Pris91l1!!:"lth Services. Inc
J05j¥,s!park Drive, Suite 200, Brentwood, TN 37027
Contractor Address:
Starting Date:
1/29.G.2[)]
Ending Date:
1/3I/29.lQ
Snmmary of contract or amendment: I year extension and new rates
~cncy/Department:

----------- -----:

. _ 11,-_FINANCIA~INFOEMA.t1~N-=-==

". ____________---------~-

Max"num Payable: - T $41,750,028 - - Pl:lOr Maxll11UIl1I$ ~<J];f2 - - -1J'':lOrj~o~,tract # (1J' Renew;l)~ [ ~-- __
Cu,:':.,,!,! Amendment: $14:9} 0.206
Cumul",tive amendments. I$ll.J.l!2,2Ql % Cumulativ-"_,<::hang~cLtII.3% .
Maximum # Units:----j
# Unit Chan~=r:::=
_ __ Prior # Units # ~~
l'ate:
I$
PrIor Rate: __.l$
_Souree of Funds - Busiuess Uuit(s): 03520
Other Fund:
Federal Fund:
%
Fund Code:
General Fund: l.lli! %
Dcpt. lD:
Dept. ID:
Dept. lD: ;J489()()4079

1._

0

[2;] Yes

No

I

_

==_

.~_

~~~-

Does this contractor meet all 3 parts of the "ABC" definition of independent contractor')
(See Bulletin 3.5) Ifnot, please indicate why this work is being arranged through a contract.

[2;]
[2;]

DYes
Yes

o

No
No

Is agcncy liable for income tax withholding or FICA?
Should contractor bc paid on the state payroll?

The agency has taken reasonable steps to control the price of the contract and to allow qualified businesses to compete Ic)r the
work authorized by this contract. The agency has done this through:
1(1 Standard bid or RFP 0 Simplillcd Bid
0 Solc Sourced
0 Qualification Based Selection
_--:: P
. _e_rsonal Service

[J

Construction

0

Architect/Engineer

o Commodity o Privatization'"

[J Other

By signing below, I certi(y that no person able to control or influence award of this contract had a pecuniary intcrest in its award
or performance, either personally or through a member of his or her household, family, or business.
DYes

[2;] No

[2;] Yes
[2;] Yes

0
0

Is there an "appearance" ofa conflict of interest so that a reasonable person may conclude that this
contractor was selected for improper reasons: (If yes, explain)
~-----------~-- ==~=~YICPRigR 1fPRgVi\.!:§ REQ!JI\{JCRQKFEQ~!fSJ'!n,>_-··· ------Contract must be approved by the Attorney General under 3 VSA §311 (a)(1 0)
I request the Attorney General review this contract as to form
~_ (initial)
No, Already performed by in-house AAG or counsel:~
DYes [2;] No Contract must be approved by the CI0lCommissioner of OIl; for IT hardware, software or services and
Telecommunications over $150,000
DYes [2;] No Contract must be approved by the CMO; for Marketing services over $15,000
[>] Yes 0 No Contract must be approved by the Secretary of Administration
- - - - - - .-----vnt A C;; ENet/lfEI'ARt M E:NT'i-tEA !lic¢iiTI E[C:A'fli)N;~.l"pp\{!.)'\7AL·
~_
.---~
I have mad~ reasonable mql~~ry-a:\i;)[Fl(:-~Zcur~7:y~)ill;~~i)~~~-,njor~';~;l()l(-Zio~
~-

ioA
I:;

9

l

I 09

No
No

A'goney I

Dep;~d

711c~,<;A' IJ AIe,,~

:ba\e--Approval by-~ (ie,;eral

Date

-~--_.~---=-~~~--=

CIO
(initial)

Date

~-

. . _ --

---=-

CMO
(initial)

-tFt!o!

Date - -

Date

Appn;;';;;\b-y Agency Sectetaty(it'teq;;;ied)
--------, -c--=-c=-=-

·~---=cc .--,~--

;'Reviewed by DHR Comm. or DHR AAG

1/-¥-{fJ (L 4i(YV1 t&
IDate

-- --

f ft!nf-zL.~_--_

Secretary of Adminitt-;1tion

ttachm~nCJ - Performance Initiatives: Replace the current Attachment J with the following: The parties agree that the terms
nd conditions of Attaehment J, including the initiatives and their respective measures, will be negotiated and added to this
3greement as a Memo of Understanding (MOU). The maximum allowable bonus for Attachment J will be $80,000 for the third
(3'd) year of the contract. The MOU will be executed by February 1,2009.

Except as modified by this above amendment, and any and all previous amendments to this contract, all provisions of this contract
# 10962 dated January 26, 2007 shall remain unchanged and in I~dl force and effect.
rhe effective date ofthis amendment is January 31,2009.

APPROVED AS TO FORM

STATE OF VERMONT
AGENCY OF HUMAN SERVICES
DEPARTMENT OF CORRECTIONS

CONTRACrrt;
Signed:

;

,/ ",

1\1 VC~; !

on/~Ith Services, Inc
-"''iI!
f.
,
I

(Please PRINT Signature)

{~;P

Address: 105 Westpark Drive
Brentwood, TN 37027
Date:

/ /? u ) DC1
-2il"~--7/'----

3

HANGE # 4

AMENDMENT
It is agreed by and between the State of Vermont, Department of Corrections (hereafter called "State") and Prison Health Services,
Inc of Brentwood, TN, (hereafter called "Contractor") that contract #] 0962 dated] /26/2007 between said State and Contractor is
hereby amended as follows:
To change Page], 3. Maximum Amolnl!, from $26,839,822 to $4] ,750,028.
To change Page 1, 4. Contract Term, from end on J/3 ]/2009 to end on 1/3 J/20 1O.
Attachment A, Section IV, Q, d: To replace paragraph 3: Failure to provide DOC inmates with medications based on the
above time-standards may result in a penalty of up to $500 per occurrence. The amount of the assessed penalty will be
determined as a result of discussion between the DOC Health Services Director and the PHS Medical Director and/or
Regional Administrator. The decision would be based on the medication and issues involved in each situation. The
Contractor shall self-report each instance of non-compliance.

Attachment A, Section IV, Q, e: To change paragraph 3, last sentence to: Failure by the Contractor to cover a shift will result in a
penalty of $600 for each uncovered shin or prorated portion thereof.
Attachment A, Section n, G: HEALTH IMPROVEMENT AND DISEASE PREVENTION :1'0 replace existing paragraph
3 with: Contractor will provide inmate health education programs and act as a consultant for facility stalf in the development of
health education/promotion groups or classes. STI/HIV risk reduction activities shall be provided by Contractor at f'lcilitics to be
Jetermined and coordinated with other State agents and contractors at remaining facilities, as authorized by the DOC and the
Vermont Department of Health.
Attachment A, Section V, D. Medical Records: To add sentence to paragraph 7: Contractor will report monthly to the DOC
Director of Health Services the number of boxes of health records by facility of discharged inmates pending archiving.
Attachment B, 1) Base Compensation: To add the following for year 3. The State will pay the Contractor an annual base
compensation (the "Base Compensation") in the amount of$] 4,] ]4,206 for the third year of the agreement which shall commence
In February I, 2009 and continue through January 3],2010. The Base Compensation is comprised of the following: (i) the
mnual actual costs (defIned in Attachment B) of providing health services which have been initially budgeted by the parties as
F12,671 ,41 0 (the Budgeted Costs) and (ii) an annual management fee of $ 1,442,796 (the Management Fee). The Base
compensation shall be paid in twelve (] 2) equal monthly installments of $], I76, 183 .83.
Attachment B, 6) Compensation for Additional Services. To add 6a) In addition to the Base Compensation payahle to Contractor,
:he State shall reimburse the Contractor separately for medications prescribed by the State's contractor of Mentaf Hcafth Services
[ell incarcerated offenders. Contractor shall invoice separately for the medications described in this paragraph. Contractor shall
mbmit an invoice On the fifteenth (] 5"') day of the month for goods provided in the previous month and the State shall reimburse
::ontractor within thirty (30) days of receipt of invoice.
"-ttachment G "- Staffing Matrix: To replace Staffing Matrix.
"-ttachment H - Stalling Coverage Standards: To replace Stafting Coverage Standards.
".ttachment ] ~ lndependence, Liability, Hold Harmless Clause: To add to last paragraph, replace fIrst sentence with: J'he
)arties agree to cooperate with each other in the investigation and handling of any potential claim, pending claim
md/or lawsuits filed by inmate(s), and/or other person(s) and/or entity or entities in connection with the Contractor's
Jerformance of services under this contract.
2

Staffing Matrix

ATTACHMENTG
A.

Correctional Facilities Summary .. Hours Per Week Per position
.

..

".,

• \,oMII'eNUeN

NORTHEAst

" " , , ' Me"N

._-.~.

f---~.-

I

....

I

Registered Nurse

I LPN

,,
,

, Nurses AIde

I

! Dentist ..

_---~--_

_-_

-Dental
- -•.. Assistant
...Dental Hygienist..

..

9

12

0

+-_.

0

20

8

.._

96

40

224

0

80
]8

0

..•

.~_

• j.--..

0

- .•- f--

,
,I

112

1-·'
I

168

~l

..•

.•

0

.

,~--.

24

I

0

18
0

192
30

7

]2

30

40
224

--._.

18

I

9

16

II

0

I

56
56

+
-+--~
I
I

.-

_. j -.

18

.

0

0

.--1---

__ ..

, Program Manager

I, Vermont
Reg Med
.

'·-1
i

I

24

208

0

112

,,~32 "

0

1616

56

168

, .384

0

3cj"

0
0

0 ...
__

30

_._+-..

o

0

0

0

0

0

0

..0

30

40

40

0

0

i

I--~~·-

I

I District Manager
I Regional
Administrator

Regional
Administrative
Assistant
-----.~---~---

40

0

0

.•-

0

..

._----_.0

__.•.

40

~--"

0
.- -_.

~-

0-1'

Ii

24

O_-t 0·'

I

t

I

I
1-_·"

i

.-

508

255

462

.. _...

~~323

4

.

.-

----

40

80
40

------1

]

40

1

80

40
40

40

40
40

I

446

I

_O~_ L.3_5_+--_~

. +.

'

I

c-------oc:;c-- _.J
35

,

j..-

40

l

~

~I~~l

._.~+---_.

I

96

'-'"1

01

,,

I

96 ..

I

0

-1

.t--~---...
45

i

1

801014°1

I

,
1-'·_._ _ _--0.

576

0

~o
+-..

.

-

I

.• j - - -

--

Contract Accounting
Manager

r----·----

•.• r···

.j---

c---..

88

I

0

0
-----_...

I

LDlf~~~?r

.+---

0

104

16

0

.._--0.

0

26

--0

-

18

I

PROG MANG/OOS

224

!

,i

.L

1
I

I

0

I-Iealth Educator.

i

I
II

I

a
0

0. _ . -

I

.+--

f---·O-····

. ..

I

Administrative
Assistant

Total Hours

16
..

40

Medical SecretaI)7/

I

18

._--.~

I

0

_

+-j-_.'.

.

5

Physicians
Physician Assistant /
, Nurse Practitioner

TOTALS

JI HeA"

• NUK' MWe'"

,,
,

225

1030

.

~....L~D
285

3579

Caledonia, VT # 220

RN

o

o

o

o

o

LPN

8

8

8

8

8

PA/NP

o

00

o

o

o

Sub-Contracted Physician

o
40

o

o

o

o

5

5

o

o
o
o

TOTAL HOURS-Nioht
TOTAL HOURS per week

45

'TBS= To be scheduled

5

Chittenden, VT # 221

Proaram Manaaer

8

8

8

8

40

8

Sub-contracted Physician

12

12

PNNP

20

20

Dentist

6

6

6

18

Dental Assistant

6

6

6

18

RN

8

8

8

8

8

40

LPN

16

16

16

16

16

16

16

112

LNA

8

8

8

8

8

0

0

40
0
0
0

RN I LPN

8

8

8

8

8

8

8

56

LPN

8

8

8

8

8

8

8

56

LNA

8

8

8

8

8

o

o

40

o

o

LPN

8

8

8

8

8

8

8

56

o
o
56

TOTAL HOUR-Nioht

508

TOTAL HOURS per week
'TBS= To be scheduled

6

Marble Valle v, VT # 223

Proqram Manaaer

6

6

6

30

6

6

Sub-contracted Phvsician

9

9

PA/NP

8

8

RN

8

8

8

8

8

LPN

8

8

8

8

8

40
8

8

56

0
0
0

I

LPN

8

I

8

I

I

8

8

I

8

I

8

I

8

I

I

56

0
0
TOTAL HOURS-Night
HOURS

56

er week

255

*TBS= To be scheduled

7

Northeast Regional, VT # 224

Proqram Manaqer

8

8

8

8

40

8

Sub-contracted Physician

7

7

PAiNP

12

12

RN

8

8

8

8

8

LPN

8

8

8

8

8

40
8

8

56
0
0
0
0

LPN

8

8

8

8

8

8

8

56

o
o
56

TOTAL HOURS-Night
TOTAL HOURS oer week

323

'TBS= To be scheduled

8

Northern State, VT #225

Proqram Manaqer

8

8

8

8

8

40

Sub-contracted Physician

18

18

PA/NP

16

16

Dentist

6

6

6

6

6

30

Dental Assistant

6

6

6

6

6

30
0

Administrative Assistant

RN

8

8

8

8

8

8

8

56

LPN

16

8

16

8

16

8

8

80

LNA

24

24
0

RN I LPN

8

8

8

8

8

8

8

56

LPN

8

8

8

8

8

8

8

56

o
o
o

LPN

56

o
o
TOTAL HOURS-Night

56

462

TOT/1L HOURS per week
·TBS= To be scheduled

9

Northwest State, VT #226

Prowam Manaqer

8

8

8

8

8

40

Sub-contracted Physician

18

18

PA

16

16

Dentist

6

6

6

18

Dental Assistant

6

6

6

18

RN

0

0

0

0

0

0

LPN

16

16

16

16

16

16

16

112
0
0

56
56

RN

o

LPN

56

LNA

56

o
TOTAL HOURS-Niaht

112

TOTAL HOURS per week

446

'TBS= To be scheduled

iO

Southeast State, VT #227

Proaram Manaoer

8

8

24

8

Medical Director

9

9

PA/NP

0

0

RN

8

LPN

8

8
8

24

8

8

8

8

8

8

56
0
0
0

LNA

8

8

8

8

8

8

8

56

o
56

TOTAL HOURS·Niaht

225

TOTAL HOURS /Jer week
*TBS= To be scheduled

] ]

Southern State, VT #228

Proqram Manaqer

8

8

8

8

40

8

Sub-contracted Physician

26

26

Sub-contracted Dentist

30

30

8

16

6

6

30

16

16

16

80

8

8

8

8

40

8

8

8

8

8

8

8

56

24

24

24

24

24

24

24

168

Clinic Coordinator

8

8

8

8

8

LNA

8

8

8

8

8

PAiNP

8

Dental Assistant

6

6

6

Medical Records Clerk

16

16

8
RN/LPN - see note 1
LPN

0

40
8

8

56

LPN

168

LNA

56

RN/LPN - see note 1
LPN

56

LNA

56

168

TOTAL HOURS-Niaht

1030

TOTAL HOURS Der week

'TBS= To be scheduled
NOTE: 1) Southern State shall have a RN manager on site 8 hours per day Monday through Friday. In addition, the day or evening shift will
maintain one RN 8 hours per day Sunday through Saturday for infirmary coverage. For any shift.where a RN is listed, a RN shall be the preferred
coverage but an LPN may be used by the Contractor without penalty if an RN is not available with the exception of the RN for infirmary coverage.
2) Southern State will continue to have RN on call coverage 24/7.

12

Vermont Regional Office #229

Medical Director

7

7

7

7

7

35

District Manaaer

16

16

16

16

16

80

Regional Administrator

8

8

8

8

8

40

Administrative Assistant

8

8

8

8

8

AO

Contract Accountinq Manaqer

8

8

8

8

8

40

Health Educator

I

I

I

I

I

I

I

I

10

10

40

40

o
o
o

o
a

TOTAL HOURS-Night
TOTAL HOURS per week

285

'TBS= To be scheduled

3579

TOTAL VERMONT DOC

]3

Staffing Coverage Standards

r··-

.-

Shift

II
I

Caledonia
Titk Hours/W
eek

,I
I

I
IDay

PA

1-····-

0
....

RN

Chittenden
Title Hours/
Week

PA/NP,
_ _______1
..

RN

0

I,PN '. .

-

20

______

1

40

Marble Valley
Title Hours/
I Week
PA/NP

8

RN

40

-

....

56

RN

I

I

40

I RN 156

...-

I RN

0

l- - --f ---

LNi\-1-

I ceN I

m

I

RN

I LPN

24

56

Southern State
Title
Hours/
Week

+---·Rf,d-56---- --

RN

"'I
II

I

I

,

I

40

iiIII
168
56

I

i

40

"I ··--56
CRN/LPN-

I

0
56

rifirm

I-

I

------------+---_.. __...

T

ro"'''

------------+--------

... -

56
40

56

ILPNI

112

I LPN!

56

!\fight_

--

,

PA/N
..... +-".
. ~,._-16
RN-

_40_1~ I m r~-'1C""P"'U~
I ~
2L
-'-

ATTACHMENT
H
-

16

I

RN

-

"".

Northeast
Southeast
Northwest
State
State
Regional
Title Hours/ Title Hours/
Title 1 Hours/
Week
Week
Week
PAl
16
I PA/NP I
12
IPA/NPI
0
NP

Northern State
Title Hours/
Week
PA/NPI

. .-

,,0_ ._.

lE"eE_ing_'
1

-

"-

.. +--+-- . _~N

1_",,6-+LPN_+-

"-~+--Lf'~!56_4LPN1--"6-j~~i:T{~·+_LN~

56

LPN
LNA
RN

168
56

o

~

I LNA

The intent of Attachment H is to provide a summary of staffing minimums required to avoid possible penalty under Attachment A, Chapter 5,
section Q" Contractor will be in compliance with this Attachment H (for all facilities except Southern in the infirmary) if only one (1) of two (2)
scheduled individuals is present for the shift With the exception of Southern State, for those shifts listing an RN position, an RN shall be the
preferred coverage, but an LPN may be used by tl,e Contractor without penalty if an RN is not available" See the Southern State matrix for notes on
the required staffing for RN manager, tl,e RN for the infirmary and the use of LPN's to replace RN's" Should contractor be unable to fill all positions
as scheduled in this Attachment H, a performance penalty may be incurred in accordance with the provisions of Attachment A, Chapter 5, Section Q"
At Northwest State, if an infirmary bed is necessitated, Contractor must have coverage per DOC/NCCHC requirements"

14