STATEOF VERMONT CONTRACT APPROVAL REQUEST -Focm

AA-14

(R'v 2/94)

Contract # 7891
Change # I

I. GENERAL INFORMATION
Agency/Department: AHSlDepartment of Corrections
Contractor: Prison Health Services, Inc
Address: lOS WestparkDrive, Suite 200, Brentwood, TN 37027
Fed.ID or Social Security#: 23-2108853
VT Dept of Taxes Business Acct#: F-26619 (if required by law)"
Start Date: February I, 2005
End Date: January 31, 2008
Summary of contract or amendment: Amend Attachment A, add new Attachment G, Hand K
II. FINANCIAL INFORMATION.
$29,534,793.00 Ifrenewal prior contract #
Maximum amt. payable under contract:
If amendment, amount of change:
Prior Maximum Amomlt: $29,534,793.00
Rate:
Prior Rate:
Source ofFunds: Gen. Fund 100 %
Fed. Source
%
Other
%
Source
Finance Codes (Appropriation and AID #): 3480004010 03520
Vendor Number: 182150
III. SillTABILITY OF PERSONAL SERVICES CONTRACT
ISl Yes 0 N a Does this contract include any supplies, materials, parts or commodities?
ISl Yes 0 No Does this contractor meet all three parts of the "ABC" defmitiou ofindeperident contractor?
(See Bulletin 3.5). If not, please indicate why this work is being arranged through a contract.
DYes ISl No Is agency liable fOIincome tax withholding or F.I.CA.?
DYes ISl No Should contractor be paid on the state payroll?
IV. PUBLIC COMPETITION
The agency has taken reasonable steps to control the price of the contract and to allow qualified businesses to compete for the work
authorized by this contract. The agency has done this through:
Formal bid or RFP
0 Simplified bid process
Other process (explain)
EBB #: C0137
Renewal #:

I

V. CONFLICT OF INTEREST
I certify that no person able to control· or influence award of this contract had a pecuniary interest in its award or performance, either
personally or through a member of his orher household, fanrily, or business.
DYes [;gJ No Is there an lIappearancef! of a conflict of iuterest so that a reasonable person may conclude that this contractor was
selected for improper reasons? (If yes, explain)
VI. PAYMENT VERIFICATION
DYes ISl No I want the Financial Operations Division to verify that payments under this contract agree with its payment
provisions, Iflcheck flNO\I understand that my agency must insure that payments made are in accordance with the provisions of the
contract.
VII. PRIOR APPROVALS REQUIRED OR REQUESTED
ISl Yes 0 No This contract must be approved by the Attorney General under 3 VSA § 311(a)(10) (over $10,000)
(1Sl YesD No Already performed by in-house A.A.G.?)
ISl Yes 0 No I request the Attorney General to review this contract as to form.
(ISlYes 0 No Already performed by in-house A.A.G.?)
ISl Yes 0 No This contract must be approved by the Secretary of Adnumstration.
TION
. curacy of he above informa~ •

DatelAp roval by Attorney Ge

ral...2L-as to forrn-2Lunder 3 VSA§ 311(a)(10)

Date Approval by Secretary of Administration

Rev. 02/04/99

CONTRACT #7891
CHANGE# 1

AMENDMENT
It is agreed by and between the State of Vermont, Department of Corrections (hereafter called "S4le") and Prison
Health Services, Inc of Brentwood, TN (hereafter called "Contractor") that contract # 7891 dated 2/1/05 between
said State and Contractor is hereby amended as follows:

1) Attachment A, Contract For Services, Specifications Of Work To Be Performed, Subsection Y.,
Administrative Services, shall read as follows:
Subsection B. Contract Implementation and Initiation Orientation
a.
Implementation
As part of its proposal, Contractor submitted a Gantt chart summarizing key implementation tasks and
anticipated timeframes for the completion of fuese tasks. In consultation with the DOC, Contractor
developed a more detailed implementation plan delineating key milestones and associated start and
end dates. This revised implementation plan is included as Attachment G of the contract.
Contractor shall meet with DOC representatives weekly to report implementation status, issues and
adherence to implementation timeframes reflected in Attachment G. The State and/or its designees
shall monitor Contractor's readiness throughout the implementation period, and may issue requests
for corrective action plans, as appropriate, should Contractor fail to meet key milestones that
jeopardize successful implementation.
In the event that Contractor fails to be fully operational by April 15,2005, Contractor may be
charged up to $25,000 per day until full operational status has been achieved. On April 15, 2005, the
Vermont DOC Administration will notify Contractor in writing of its assessment of operational status
- fully operational or non-compliant. Compliance shall be based upon completion ofthe key
milestones in Attachment G, as determined by the VDOC. The DOC shall detail all compliance
shortfalls by facility and function. Contractor will develop detailed corrective action plans for all
non-compliant facilities and functions within five calendar days of receipt ofthe DOC operational
assessment letter.
Once the DOC has notified Contractor in writing fuat full operational status has been achieved, fuis
provision (and its associated performance guarantee) will no longer be applicable for the remainder of
the contract.
Subsection Q. Performance Guarantees
g.
Implementation Plan
In the event that Contractor fails to be fully operational by April 15,2005, Contractor
may be charged up to $25,000 per day until full operational status bas been achieved.
The size of the penalty shall be proportionate to Contractor's shortfall in operational
readiness. The VDOC shall determine completion offue key milestones in PHS'
Implementation Plan on April 15, 2005, and notify Contractor in writing of its assessment
of operational status - fully operational or non-compliant - detailing all compliance
shortfalls by facility and function. Detailed corrective action planes) for all noncompliant facilities and functions are required from PHS within five calendar days of the
DOC operational assessment letter.
Once the DOC has notified Contractor in writing that full operational status has been
achieved, tbis performance guarantee will not longer be applied throughout the remainder
of the contract period.
2

2) The following language is added to the end of Attachment A, III, Personnel Services, A. Overview:
The DOC recognizes that demand for staffing coverage is subject to change as the mission, size·
and role of the specifwDOC institutions change. It behooves the DOC and the Contractor to
have flexibility in responding to these demands. To insure that staff assignments match the
clinical and/or administrative need of each site, and that staff arc optimally deployed throughout
the state, the DOC agrees to permit minor changes in the Staffing Matrix (Attachment H). Such
minor changes shall be: .
•
•
•
•

Discussed in adVance by the Executive Health Committee,
Made in accordance with mutually-agreed upon plans between the DOC and Contractor,
signed off by both parties,
Contingent upon the total statewide number of positibns remaining unchanged, and
Memorialized in an updated Staffing Matrix, maintained by the Executive Health
Committee, copied in the DOC Buisness Office Contract File.

In addition, the Department of Corrections received and approved a revised staffing proposal from PHS.
To insure that PHS' staffing matrix met the DOC's clinical and administrative requirements, the DOC
approved the proposed staffing matrix for the first four months of the contract, with the following
provisos:
•
•
•

The DOC and Contractor shall meet on May 2, 2005 to discuss their respective assessments of the
staffing matrix,
Any changes to the matrix, proposed by either the DOC or Contractor to improve service delivery,
shall be presented at that meeting,
Staffing changes accepted by the DOC and the Contractor which result in a reduction to the agreedupon contract maximum amount (no increase will be accepted by the DOC), will cause the DOC to
amend the contract no later than May 31, 2005.

3) The following language is added to the end of Attachment A, II, Health Care Services, W., Pharmaceuticals:
The State will cause a financial plan and design a performance audit to be conducted relative to
pharmaceuticals. Said audit will be conducted on or about June 30, 2005. If in the determination of the
State,savings can be achieved relative to pharmaceuticals, the State will take the pharmaceutical portion
oftms contract to bid and reserves the right commencing January 1,2006, to obtain pharmaceutical
products and services from a different provider. In the event that the State opts to obtain pharmaceuticals
from a different provider, all other terms of this contract shall remain in effect.
4) This amendment adds new Attachment G, PHS Implementation Plan, Attachment H, Staffing Matrix, and
Attachment K, Staffing Coverage Standards (attached).
Except as modified by this above amendment, and any and all previous amendments to this contract, all
provisions of this contract #7891 dated 2/!/05 shall remain unchanged and in full force and effect.
The effective date of this amendment is 4!l5/05.

3

APPROVED AS TO FORi\1:

Attorn

General's Office

Date:~-",o,-",Io,--_

STATE OF VERMONT
AGENCY OF HUMAN SERVICES
DEPARTMENT OF CORRECTIONS

Robe
Date:_ _-f----jL-

_

Signed:-H~'fP-yY>¥==,.,,__o>r-

(Please P
Address: 105 Westpark Drive, Suite 200
Brentwood, TN 37027
SS#/F. ed ID#: /-21088 53
.; 2$/,xDate:

i

t

4

Attachment G - PHS Implementation Plan
.

i~lt~fjs

~D;
1
2

Contract
Establish management meeting schedule and implementation agenda

12/15/04 01/12/05 Complete
12/15/04 12/17/04 Complete.

3

Review implementation time frame and confirm with PHS team and DOC

12/15/04 01/31/05

Complete

4
5
6
7

Inform PHS subconttactors of conlTact award
Establish Pharmacy Services
Arrange for Back-up Pharmacy Services
Contact local health departtnent and other commUnity resources

12/15/04
12/06/04
12/15/04
12/15/04

12/31/04
12/24/04
01/10/05
12/20/04

Complete
Complete
Complete
Complete

8

11/15/04 11/22/04

Complete

11

Obtain current employee list and provide to PHS human resource
departtnent
Begin and complete facility assessment tours - all sites to include inventory
of medical supplies
Inform CMS personnel of conttact award
Finalize PHS and operational teams to include on site Management Team

12
13

Facility tours status report to client
Review employee retention potential with PHS resources unit and DOC

14

12/22/04 12/22/04 Complete
11/29/04 12/22/04 Complete
12/06/04 01/31/052 Complete,
12/15/04 01/18/05 Complete'
12/15/04 02/15/05 Complete
12/15/04 03/01/05 Complete

Nel',otiate and finalize facility staffing and service matrix
Interview and make offers to current employees
Interview and make offers to new employees
Develop post orders and job responsibilities to each shift to include clinical
aspects and submit to client
Obtain security clearance for PHS staff from client
12/15/04 01/17/05
Submit names of management team to client for approval
12/06/04 01/03/05
Develop staff meeting schedule and provide copy to client
01/04/05 01/17/05
Regional Director start date ...
01/03/05 01/03/05
Medical Director/Physicians start date (if new staff)
01/17/05 01/17/05
Program Managers start date
01/17/05 02/01/05
RN /LPN start date (if new staff)
01/17/05 02/01/05
Administrative assistants start date (if new staff)
01/24/05 02/01/05
New staff orientation and ttaining
01/17/05 01/31/05
Pharmacy In-service for Staff
01/17/05 01/31/05
Orient all current employees to PHS policies to include approved protocols, 01/03/05 03/01/05
PHS utilization review
Establish site personnel files
01/04/05 01/24/05
01/17/05 04/01/05
Establish payroll system - installation of Chronos clock

9

ii

\

Awarded1

.

II,

11/29/04 12/17/04 Complete

.

! 10

i 15

16
17
!

I

,

18
19
20
21
22
23
24
25
26
27
28
29
30

.

11/29/04 12/17/04 Complete
12/06/04 01/19/05 Complete

Complete
Complete
Complete.
Complete II
Complete I
Complete i
Complete i
Complete
Complete
Complete
Complete
Complete
Complete

Implementation dates contained in this Attachment were adjusted, with DOC approval, due to the delay in the
conttact award date from December 15,2004 to January 12, 2005.
2 To insure that PHS' staffing mattix met the DOCs clinical and administrative requirements, the DOC approved
the proposed staffing mattix for the first four months of the conttact, with the following provisos: 1) The DOC
and Contractor shall meet on May 2, 2005 to discuss their respective assessments of the staffing matrix; 2) Any
changes to the matrix, proposed by either the DOC or Contractor to improve service delivery, shall be presented
at that meeting, 3) Staffing changes accepted by the DOC and the Conttactor which result in a reduction to the
agreed-upon conttact maximum amount (no increase will be accepted by the DOC), will cause the DOC to amend
the contract no later than May 31,2005.
5

1

~ ,::",~~"
31

I

! 32
33
34
35
i
i

36
37
38
39
40

i,
,

41
42
43

I

-

Develop emergency telephone numbers and contact information and
12/15/04 02/01/05
provide to client (for both'implementation and operational teams)
Orient staff to PHS Information System requirements as needed
01/24/05 02/15/05
Develop in-service trai1:ting annual schedule
01/04/05 03/01/05
Complete review of all client's current policies, procedures, manuals and
12/06/04 02/28/05
forms
Develop new policies and procedures, manuals and forms as needed,
12/22/04 02/28/05
review with client and obtain approval
Develop work schedules and assignments
12/20/04 02/28/05
Provide proposed service schedule for clientfor approval
12/06/04 02/28/05
Develop on-call schedules as required and provide to client
12/06/04 01/31/05
Review and develop chronic care clinic schedules and submit to client for
12/15/04 02/28/05
, informational purposes
Obtain insurance certificates and coordinate insurance requirements with
12/15/04 12/31/04
corporate counsel and provide copies to client
Order all medical supplies
01/10/05 01/21/05
Order all office sllpplies to inclllde forms relevant to providing services
01/10/05 01/24/05
.
specific to client
Establish petty cash fund
01/17/05 01/31/05
,
Coordinate the transition of Health Service program from current provider 12/15/04 01/31/05
toensurecontinui~

45
46
47
48
49
50
51

:
52
~

53

Complete
Complete
Complete
Complete
Complete
Complete
Complete
Complete
Complete
Complete
Complete
Complete
Complete
Complete',
,

Coordinate fiscal responsibilitv with current provider3
Meet with Mental Health Provider
Assist in determining the requirements necessary for interface with facility
MIS system
Coordinate, receive and install neW compllters
Install phones, fax machines, computer lines (assuming DOC network
integration. If not achievable, CMS land lines will be maintained)
Facilitate communication access (telephones, pa!?;ers)
Transfer Patient Information via medication administration recOrds for
DOC inmates as of 1/15/05
Transfer Patient Information daily via medication administration records
for DOC inmates with intakes after 1/15/05
Test MIS system for reporting capabilities to meet contract requirements.

12/15/04 02/25/05 Complete
01/17/05 01/21/05 Complete
12/15/04 01/14/05 Complete
12/15/04 02/01/05 Complete
12/15/04 02/01/05 Complete
01/04/05 01/17/05 Complete
01/15/05 01/21/05 Complete
. 01/15/05 01/31/05 Complete
01/14/05 01/31/05 Complete

Process requires reconciliation between the estimated supplies and equipment to be purchased by the
Contractor from the incumbent and supplies and equipment left on-site as of February 1, 2005. Contractor shall
complete reconciliation and compensate the incumbent no later than February 25, 2005,
3

6

I

Attachment H - Staffing Matrix
A. CORRECTIONAL FACILITIES SUMMARY - HOURS PER WEEK PER POSITION

Physicians
Physician Assistant
Nurse Practitioner
Registered Nurse
Licensed Practical Nurse
Licensed Nurses Aide
Dentist'
Dental AssistantS
Dental Hygienist
Medical SecretaryI
Administrative Assistant
Program Manal';er
Vermont Regional
Director
Senior Program Manager
Patient Advocate

2
4
0
40
28
0
0
0
0
2

10
0
20
80
208
112
32
32
0
24

6
0
8
112
56
0
. 0
0
0
0

8
8
0
40
1521
0
0
0
0
8

16
16
0
112
1922
0
0
0
0
30

2
0

16
40

16
0

8
0

30
0

0
0
78

I

40
40
654

I

0
0
198

I

0
0
224

I

0
0
396

6
12
0
40
1523
0
0
0
0
8

I

·8
0
0
0
226

.

f

I

16 .
12
0
40
224
0
24
24
0
16

8
0
12
40
128
0
0
0
0
0

20
0
24
376
280
112
40
40
0

24
0

24
0

32
0

0
0
380

I

0
0
212

92
52
64
880
1,420

224
96
96
0
160

72.

I

0
0
996

I

160
. 40
40
40

·3,364

T(J{al Hours

1 PHS is current staffing RNs (112 hours per week) in LPN positions reflected in the staffing matrix. PHS hired CMS RN staff to cover these LPN position to
ensure continUity. of service during the transition. PHS believes that the LPN positions reflect good operational and clinical practice, and plans to transition
to LPNs in these positions over time.
2 See Footnote 1. Northern State has 56 LPN hours staffed by RNs.
3 See Footnote 1. Northeast Regional has96 LPN hours staffed by RNs.
4 Dentist hours are reported in the three facilities where services are rendered: Chittenden, Northwest and Southern: but include hours designated to deliver
services to inmates at all nine DOC facilities.
5 Dental Assistant hours are reported in the three facilities where services are rendered: Chittenden, Northwest and Southern, but include hours designated
to deliver services to inmates at all nine DOC facilities.

INDIVIDUAL FACILITIES

Caledonia

.
Medical Director
Dentist
Dental Assistant
Physician Assistant
Program Manager
Administrative Ass't
Registered Nurse
Licensed Practical Nurse
Licensed Nursing Ass't

2
.

2
2

2

.

2
8'

8

8

8

8

TOTAL HOURS/ FTE-DAY

Re2:istered Nurse
Licensed Practical Nurse
Licensed Nursin2: Ass't

4

4

4

4

4

4

4

0.05
0.00
0.00
0.10
0.05
0.05
1.00
0.00
0.00
1.25

o

0:00
0.70
0.00
0.70

28

o
TOTAL HOURS/ FTE-EVENING

istered Nurse
Licensed Practical Nurse
Licensed Nursin2: Ass't
Total Hours/ FTE-NIGHT
Total Hours/ FTE PER WEEK

!

2
0
0
4
2
2
40
. 0
0
50

...,. I -1:5:;) ::: -lobe scheduled

2

28

2) Chittenden

8
8
8

Vermont Regional DirectorG
Senior Program Manager7
Patient AdvocateS
Medical Director
Dentist
Dental Assistant
Nurse Practitioner
Program Manager
Administrative Ass't
Registered Nurse
Licensed Practical Nurse
Licensed Nursing Ass't

8
8
16
8

8
8
16
8

8
16
8

8
16
8

'Registered Nurse
Licensed Practical Nurse
,Licensed Nursing Ass't

8
8
8

8
8
8.

8
8
8

8
8
8

Recistered Nurse
Licensed Practical Nurse
Licensed NursinlZ Ass't

8
8
8

8

8
8
8
5
8
8

8

8
8
8
8
8
8
8

.

8

8
8
8
5
8
8

8
8
8

4
8

8

.

8
8
16
8
8
8
8
8
TOTAL HOURSjFTE-DAY

8
8
8
8
8
8
8
TOTAL HDllRSjFTE-EVENING

8

8

8

40
40
40
10
32
. 32
20
16
24
40
96
56
446

1.00
1;00
1.00
0.25
0.80
0.80
0.50
0.40
0.60
1.00
2.40
1.40
11.15

40
56
56
152

1.00
1.40
1.40
3.80

o

0.00
1.40
0.00

56

o
TOTAL HOURSj FTE-NIGHT
TOTAL HOURS/ITE PER WEEK

56
654

*TBS ;;;; To be scheduled

While the Regional Manager is assigned to Chittenden, the post would provide services to all Vermont DOC facilities.
7 While the Senior Program Manager is assigned to Chittenden, the post would provide services to all Vermont DOC facilities.
SWhile the Patient Advocate is assigned to Chittenden, the post would provide services to all Vermont DOC facilities.
6

3

lAO
16.35

Medical Director
Dentist
Dental Assistant .
Nurse Practitioner
Program Manager
Administrative Ass't
Registered Nurse
ILicensed Practical Nurse
ILicensed Nursing Ass't

..

6
.
.

4
8

4
8

.

8

8

8

8

8 .

8

8

TOTAL HOURSj FTE-DA Y

Recistered Nurse
Licensed Practical Nurse
Licensed N ursin 2: Ass't

8

8

8

8

8

8

8

6
0
0
8
16
0
56
0
0
86

0.15
0.00
0.00
0.20
0.40
0.00
1.40
0.00
0.00
2.15

o

0.00
1.40
0.00
1.40
4.95

56

o
TOTAL HOURSjFTE-NIGHT
TOTAL HOURS/FIE PER WEEK:

~
*TBS;: To be scheduled

4

I

I

56
198

\l!erucal Director
Dentist
Dental Assistant
Physician Assistant
Program Manager
Administrative Ass't
Registered Nurse
Licensed Practical Nurse
(Filled by RN as 0[2/1/05)
Licensed Nursing Ass't

8

8
"
8

.

.

8

8
0
0
8
8
8
40

8

8

8
8

8

8

8

.

8
8

.

.

8

I

I

I

I

I

8

I

56

8

I

I

TOTALHOURS/ FTE-DAY

',i;ii; Hi),.»)>· i""ii»).,!,;

i!'ii)'!!') iiH"i:iii'iJiiiiiii',i!!!,iiiii!ii"ii!;Ji!,l;;i~~ 1'1'ii!!i
c

Registered Nurse
Licensed Practical Nurse
(Filled blf RN as of2/1/05)
!Licensed Nursing Ass't

8

8

8

8

0
~28

0

.

8

I

1

8

8

8

-

-_.....-

8

8

8

J.

.

TOTAL HOURS/ FTE"NIGHT
TOTAL HOURS/ FTE PER WEEK
*T88 = To be scheduled

5

I

0.00

I

0.00

1 -3.20
1.40

0

0.00
1040

'i>i i'"

8

1.40

56
56

Registered Nurse
Licensed Practical Nurse
,Licensed Nursing Ass't

I

0
40
0
40

224

i,i!ii!'i'
0.00
1.00
0.00
1.00
5.60

5) Northern

Medical Director
Dentist
Dental Assistant
Physician Assistant
Program Manager
Administrative Ass't
Registered Nurse
IILicensed Practical Nurse
'Licensed Nursing Ass't

8

8
"

8
8
6
8
16

8
6
8
8

8
8
6
8
8

6
8
16

6
6
8
16

8
8

8
8

TOTAL HOURS/ FTE-DAY

DAD

16
0
0
16
30
30
56
80
0
228

0.00
0.00
0.40
0.75
0.75
1.40
2.00
0.00
5.70

·iiii/!iiY!!!'·i!,!!!iiiiii!;i!!!;V!V/Yiii!.iiiiii; /i.i""i\.iii.iiWi'i.!!

8
8

Registered Nurse
Licensed Practical Nurse
Licensed Nursing Ass't

8
8

8
8

8
8

8
8

8
8

8
8

.

TOTAL HOURS/ FTE-EVENING

;i'i·;' 'i .• i;!i!;!i';i •• '!!!!"

IRo;;;:i 0'0"0.1 Nurse
Licensed Practical Nurse
(Filled bV RN as of 2/1/05)
L~censed Nursing Ass't
.

;ii!i';;;'!i /.'.;i•. "'Hiiii!i;ii'!ii;!;jm)"i'ij.j.milliiilljijiijiiij~~;H,H·)".!}i}!')"!i)

1

1
8

1

1

8

8

1
8

1
8

I
8

I
8

lAO
lAO

56
56
0
112

I

0.00
2.80

0

I

0.00

56

I

lAO

.

f

TOTAL HOURS/ FrE-NIGHT
TOTAL HOURS/ FTE PER WEEK'

_.

*TBS "" To be scheduled

6

0
56

0.00
1.40

396

9.90

Medical Director
Dentist
Dental Assistant
Ph sician Assistant
Pro ram Mana er
AdrrUnistrative Ass't
Re .stered Nurse
Licensed Practical Nurse
(Filled by RN M-F (40 hrs) as of I
2/1/05)
Licensed Nursinp: Ass't
I
i!iiu(iiijiici,i'iUiiiiiiiUitiii

!Registered Nurse
'Licensed Practical Nurse
(Filled bV RN as of2/1/05)
Licensed Nursing Ass't

6

6

6
0
0
12

6

8
8
8
8

8

I

8

I

iiiu·iiii.iVuuU·iiiji]iiiii

8

8
8

8

I

8

I
i"iiiij.iiiiijUi

8

8

I

8

8

8

I

8

I

I
;iiii.

40

I

8

I

I

8

I

~AL HOURS/FTE-DAY

I

I

56

I

1.40

I

I
I

0
130

I
I

0.00
3.25

iWiiiiijii,iijii iiiijiiji,iiijii

8

8

8

8

TOT A r, HOURS/ FTE~EVENING

~irrillliii'i;;i!i"'Ct?'Ui'U'U'·i.'i

!iiitriiiiiiijiii,liliiiiU,i,iCti ii.i'i',ii?'i·'ii?iiCtiii'i!!··i

.iii."i,i'" i
Registered Nurse
Licensed Practical Nurse
Licensed Nursing Ass't

8

8

8

0.15
0.00
0.00
0.30
0.20
0.20
1.00

8

8

TOTAL HOURS/ FTE-NIGHT
TOTAL IIOURS/FTE PER WEEK
*TBS = To be scheduled

7

,

0

0.00

56

1.40

0
56

0.00
1.40

0
40
0
40
226

0.00
1.00
0.00
1.00
5.65

Medical Director
Dentist
Dental Assistant
Physician Assistant
Program Manager
Administrative Ass't
Registered Nurse
Licensed Practical Nurse
Licensed Nursing Ass't

8

8
8
8

8
8
6
8

8

8

8

8

8
8
8
(j

8
8
8
8

8
8
8

8
8

8

8

TOTAL HOURS/FTE-DAY

Registered Nurse
Licensed Practical Nurse
Licensed Nursing Ass't

16

16

16

16

16

16

16

TOTAL HOURS/ FTE-EVENING
..

Registered Nurse
Licensed Practical Nurse
Licensed Nursing Ass't

• • '.'

8

8

• " ,.

.. J

8

•

8

8

.

'0;:' .':","
8

o.

"..

8

TOTAL HOURS/ FTE-NIGHT
TOTAL HOURS/FTE PER WEEK

~-------------------~~~~~~
*TBS =: To be Scheduled

8

'.-

0

.,

16
24
24
12
'24
16
40
56
0
212

0.40
0.60
0.60
0.30
0.60
0.40
1.00
1.40
0.00
5.30

0
112
0
112

0.00
2.80
0.00
2.80

'.
'0
56
0
56
380

.

.
0.00
1.40
0.00
1.40
9.50

8) Southeast State

IIMedical Director
Dentist
Dental Assistant
Nurse Practitioner
Program Manager
Administrative Ass't
Registered Nurse.
Licensed Practical Nurse
Licensed Nursing Ass't

4

6
8
8

8

4

$

6
8

8

8

8
0
0
12
24
0
40
16
0
100

.
.
8

.

8

8

TOTAL HOURSjFTE-DAY

llll'ffil%fli"! "!:::::'::!,'",',II'lfll'f',ill'll!!'ll','",):::"il):'::!':::'::'.':,""::"ll'1:,,',1'" ,,'i'::ilil'::il,", W,',w"
Registered Nurse
Licensed Practical Nurse
Licensed Nursing Ass't

8

8

8

::'i',:iiilil::'il/'Ji:Ill',:
8

8

8

:::W:'"',,::,,,,'::w::W,!,I,!!,
8
.

TOTAL HOURSjFTE-EVENING

0
56
0
56

!!'l,ll',ll'llUlm,II!!',mlIUllill'rf il :::: ",:i'il'! ",:Ill'!!"':!ilil:'ljiill!!'
egistered Nurse
5censed Practical Nurse
kensed Nursing Ass't

8

8

.
_.- - -

8

8 .

--

8

8

*TBS

:=

8

TOTAL HOURSj FTE-NIGHT

,--~~~~~~~~~~~~~~~~~~~~~~~T~O=TA=L,;;;H;;.;O-,U;;;;R;.;;;S;;;.;;;VFTE
To be scheduled

9

0.20
0.00
0.00
0.30
0.60
0.00
1.00
DAD
0.00
2.50

PER WEEK

0
56
0
56
212

0.00
1 AD
0.00
1.40

9) Southern State

Medical Director
Dentist
Dental Assistant
Nurse Practitioner
Program Manager
Administrative Ass't
Registered Nurse
Licensed Practical Nurse
Licensed Nursing Ass't
RN - Infirmary

4
8
8
8
8
16
16
16
8
8

4
8
8

8
16
16
8
8

4
8
8
8
8
16
16
16
8
8

4
8
8
8
16
16
16
8
8

4
8
8

20
40
40
24

~
8
16
8
16
8
16
16
16
8
8
8
8
8
8
TOTAL HOURSI FTE-DA Y

32

72
96
112
56
56
548
i'iT Ti

Registered Nurse
Licensed Practical Nurse
Licensed Nursing Ass't
RN - Infirmary

8
16
8
8

8
16
8
8

8
16
8
8

8
16
8
8

Registered Nurse
Licensed Practical Nurse
Licensed Nursing Ass't
RN - Infirmary

8
8

8
8

8
8

8
8

8

8

8

8

*TBS :::: To be scheduled

10

8
8
8
16
16
16
8
8
8
8
8
8
TOTAL HOURS/ FTE-EVENING

8
8

8
8

8
8

8
8
8
TOTAL HOURS/ FTE-NIGHT
TOTAL HOURS/FTE PER WEEK

0.50
1.00
1.00
0.60
0.80
1.80
2.40
2.80

lAO
1.40
13.70

:"":i'' 1,1,'' ,,1,,11,1;il
56
112
56
56
280

56
56
0
56
168

996

lAO
2.80

lAO
1.40
7.00

1.40
1.40
0.00 ,

lAO
4.20
24.90

Attachment K
Staffing Coverage Standards

-.-._---LPN I

40

I LPN

I 56

I LPN I 40 I LPN I 56

-.-.~----

---~.+-~~

RN

~---

RN-

I LPN I 40=:J: LPN I 56--' LPN I 56

r

I

56

I

56

Infirm
LPN I

56

The above matrix reflects Contractor's Staffing Matrix (Attachment H) for PAs, NPs, RNs, LPNs and LNAs with the reduction of forty hours per week or the
equivalent of one (1) FTE per shift for the highlighted positions. 'The intent of Attachment K is to provide a definition of an uncovered shift. For highlighted
positions, Contractor will be in_compliance if only one (I) of two (2) scheduled individuals of the same title are present for the shift. Should Contractor be unable
to fill all positions as scheduled in Attachment K, a performance penalty will be incurred. Contractor may, at its discretion, fill clinical positions with higher
practice level professionals - charging the DOC at the cost of the regularly scheduled health profession - without penalty.

Northern day shift has two LPNs on Monday, Wednesday and Friday. Contractor will be in compliance if only one of two scheduled individuals
are present on these three days.
12

- 11 •

\