STATE OF VERMONT CONTRACT APPROVAL REQUEST -Foem

AA-14 (Rev 2/94)

Contract # 7891
Change # 2

I. GENERAL INFORMATION
AgencylDepartment: AHS/Department of Corrections
Contractor: Prison Health Services, Inc
Address: 105 Westpark Drive, Suite 200, Brentwood, TN 37027
Fed. !D or Socia! Security #: 23-2] 08853
VT Dept of Taxes Business Acct #: F-26619 (if required by law)
Start Date: February 1,2005
End Date: January 31, 2008
Summary of contract or amendment: Changes to Attachments to Staffing Matrix "H" and Coverage Standards in Matrix "K";

agreements regarding penalties for" no shift left uncovered";
II. FINANCIAL INFORMATION
Maximum arnt. payable under contract:
I f amendment, amount of change:

$29,534,793.00

Ifrenewal prior contract #
Prior Maximum Amount: $29,534,793.00

Rate;
Prior Rate:
Source of Funds: Gen. Fund 100 %
Fed. Source
%
Other
Finance Codes (Appropriation and AID #): 3480004010 03520
Vendor Number: 182150

%

Source

III. SUITABILITY OF PERSONAL SERYICES CONTRACT

1:8] Yes D No Does this contract include any supplies, materials, parts or commodities?
1:8] Yes D No Does this contractor meet all three parts of the "ABC" definition of independent contractor?
(See Bulletin 3.5). If not, please indicate why this work is being arranged through a contract.
DYes
DYes

1:8] No ]s agency liable for income tax withholding or F.l.C.A.?
1:8] 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
D Simplified bid process
Other process (explain)
EBB #: CO I37
Renewal #:
V. CONFLICT OF INTEREST
I celiify that no person able to control or influence award of this contract had a pecuniary interest in its award or perfonnance, either
personally or through a member of his or her household, family, or business.
DYes [8J No Is there an "appearance" of a conflict of interest so that a reasonable person may conclude that this contractor was
selected for improper reasons? (lfyes, explain)

VI. PAYMENT VERIFICATION
D Yes ~ No J want the Financial Operations Division to verify that payments under this contract agree with its payment
provisions. If I check llNO", I understand that my agency must insure that payments made are in accordance with the provisions of the
contract.
VB. PRIOR APPROVALS REQUIRED OR REQUESTED
1:8] Yes D No This contract must be approved by the Attol11ey General under 3 VSA § 311 (a)(1 0) (over $10,000)
(1:8] YesD No Already performed by in-house A.A.G.?)
1:8] Yes D No I request the Attorney General to review this contract as to form.
(1:8] Yes D No Already performed by in-house A.A.G.?)
1:8] Yes D No This contract must be approved by the Secretary of Administration.
I
'u1]S~o--f'tli'e above information.

2

Rev. 02/04/99

AMENDMENT
It is agreed by and between the State of Vermont, Department of Corrections (hereafter called "State")
and Prison Health Services, Inc., a Delaware corporation with its principal office in Brentwood, TN
(hereafter calied "Contractor") that contract # 789 I dated 211105 between said State and Contractor is
hereby amended as follows:

I) Attachment A, Contract For Services, Specifications Of Work To Be Performcd, Chapter III.,
Personnel Services, Section A., Overview, page 26, Subscction a., is amended as follows:
a. Thc health care statr currently classified as Vermont State Employees assigned to the State
Correctional facilities will be permitted to retain their state employment status. The State and Contractor
shall comply with the terms of the Stipulation and Agreement between the State and the Vermont State
Employees Association, dated luI 31, 1996, incorporated here by reference. It is expressly understood and
agreed that the Contractor is not a party to nor obliged to any contract or agreement with and between the
State of Vennont and the Vermont State Employees Association. The state agrees to waive any and all
penalties related to staffing for one or more positions designated as being filled by a State employee in the
event of a work action or stoppage by the Vermont State Employees Association.
2) Attachment A, Contract for Services, Specifications of Work to bc Performed, Chapter V.,
Administrative Services, Section Q., Performance Guarantees, the last paragraph of Subsection e., page
51, under "staffing standards and coverage", is amended as follows:
e.
Contractor must also ensure that no shift is left uncovered. The definition of a shift is 8 hours.
Contractor may, at its discretion and cost, fill clinical positions with higher practice level professionals
without penalty or increased cost to the DOC. In those instances where an RN or LPN is permitted to
cover a shift as outlined in Schedule K, Contractor agrees to reimburse the DOC for the reduction in cost
to till RN posts with LPN's. Clinical staff cannot be asked to operate outside of their scope of practices to
cover a shift. Failure by the Contractor to cover a shift will result in a penalty of $1 ,000.00 for each
uncovered (vacant) shift. Attachment K - Staffing Coverage Standards reflects the minimum staHing
required by facility, by shift, by type of clinical staff for Contractor to avoid a penalty under this
provision. In the event Contractor provides nursing coverage for a portion of a shift, i.e., 2.5 hours of an 8
hour shift, Contractor shall be assessed a penalty of $125 per hour per day for each shift partially covered.
It is further agreed that Contractor will maintain a nursing presence at all times in all facilities, 24 hours a
day, 7 days a week, 365 days per year as specified in Attachment H. Under this amendment, this results in
the addition of the following staffing hours:
•
72 hours/week at Dale Correctional Facility
•
72 hours/week at Northeast (for joint evening coverage of Caledonia Work Camp and
Northeastern Correctional Facility)
•
16 hours/week at Marble Valley (LPN)
•
24 hours/week at Southeast Correctional Facility (LPN)
•
40 hours/week at Southern State Correctional Facility (LPN)

Recognizing that demand for nursing coverage is subject to change as the mission, size and role of the
specific DOC institutions change; it is in the interest of DOC and the Contractor to have flexibility in
responding to these demands. To insure that staff assignments match the clinical and/or administrativc

3

need of each site, and that staff are optimally deployed throughout the state, the DOC may, at its
discretion, permit minor modifications within the framework of the Staffing Matrix (Attachment H)
without amending the full contract provided there is no substantial financial impact. These modifications
will be agreed to by both parties in writing. It is within the sole discretion of the DOC to determine what
constitutes substantial financial impact.
Nurse Practitioners, Physicians, Dentists, Dental Hygienists, Physician Assistants are expected to maintain
a regular schedule. Recognizing that demand for medical services fluctuates, it is in the interest of DOC
and the Contractor to have flexibility in responding to these demands. Understanding that clinical demand
may result in fluctuations in the number of hours to be spent at a given site on a particular day, DOC
reserves the right to waive those penalties related to uncovered shifts that might otherwise be incurred in
accordance Section Q, Performance Guarantees, paragraph e., Staffing Standards and Coverage.
3) Attachment H, Staffing Matrix, and Attachment K, Staffing Coverage Standards are both amended
by deleting them in their entirety and replacing them with the revised Attachment H and Attachment K,
attached hereto.
4) Attachment B, Payment Provisions, Section (1), Base Payment is amended by adding the following
additional provisions:
In consideration of the staffing adjustments contained in this amendment, the State agrees to pay the
Contractor an additional sum of $29,659.14 per month.
Insofar as many of the staffing adjustments contained herein have already been implemented in
anticipation of this amendment, the State agrees to pay the Contractor an initial sum of$59,318.28 ( 2
months) upon execution of this amendment and receipt of invoice.
Except as modified by this above amendment, and any and all previous amendments to this contract, all
provisions of this contract # 7891 dated 2/1/05 shall remain unchanged and in full force and effect.
The effective date of this amendment is ]0101/06.
STATE OF VERMONT
AGENCY OF HUMAN SE VICES

APPROVED AS TO FORM:

DEPART

Date:

NTIOORR 'eTIONS

/1111; /01"
J

7

(Please PRINT Signature)

APPROVED AS TO FORM
4

bYLEG~L~7

---SBS'~~

Attachment H - Staffing Matrix

I

A. CORRECTIONAL FACILITIES SUMMARY - HOURS PER WEEK PER POSITION
.
,

.

~

,

Dale

Marble
Vallev

:1

I

II!
iPhvsicians
!Physician Assistant
INurse Practitioner
Registered Nurse
ILicensed Practical Nurse
ILicensed Nurses Aide
IDentisF
IDental AssistantS
Dental Hygienist
Med Sec/ Admin.
Program Manager

Total Hours
PHSR .
10m
Vermont Reg. Director
Senior Program Manager
,I Patient Advocate
....

Caledonia Chittenden

I HTotal

Northern
NE
Southern I
State
State
Regional NW State SE State

ours

2
4
0
40
02
0
0
0
0
0
0
46

10
0
20
80
208
112
18
18
0
0
40
506

6
0
8
96 1
128 3
0
0
0
0
0
24
262

8
8
0
40
1684
0
0
0
0
0
40
264

16
16
0
112
192
0
30
30
0
30
40
466

6
12
0
40
224 5
0
0
0
0
0
40
322

16
12
0
40
224
0
18
18
0
0
40
368

8
0
12
40
152 6
0
0
0
0
0
24
236

20
0
24
376
320 9
112
30
30
0
80
40
1032

92
52
64
864
1616
224
96
96
0
110"0
288 11
3502

0
0
0
0

40
40
40
120

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0.•

40
40
40
120

IVUA). ...., • .1.1.........

iTotal Hours

Replaces 16 hours weekend RN coverage \vith LPN hours
Eliminates 4 hours/week evening LPN shift (total reduction 28 hours)
3 Adds 72 hours LPN coverage
4 Adds 16 hours LPN coverage
Adds 72 hours LPN joint coverage
6 Adds 24 hours LPN coverage
9 Adds 40 hours LPN coverage
7 Dentist hours are reported in the three facilities where services are rendered: Chittenden, Northern, Northwest and Southern, but include hours designated to deliver services to inmates at all
nine DOC facilities.
8 Dental Assistant hours are reported in the three facilities \vhere services are rendered: Chittenden, Northern, Northwest and Southern, but include hours designated to deliver services to
inmates at all nine DOC facilities.
,-D Eliminates 50 hours Admin coverage
'-l Adds 128 hours Program Manager coverage
1

2

5

I

I

I

B. INDIVIDUAL FACILITIES

1.), Caledonia
POSITION

MON

TUE

WED

THU

FRI

SAT

SUN

TBS'

HRSI
WK

DAYSHIFT
Medical Director
Dentist
Dental Assistant
Physician Assistant
Program Manager
IAdministrative Ass't
IRegistered Nurse
Licensed Practical Nurse
Licensed Nursing Ass't

I
2

2

8

8

2

8

8

8

2
0
0
4
0
0
40
0

a
TOTAL HOURS/DA Y

46

EVENING SHIFT
r;;
.
Il~egistered Nurse

a
a
a

Licensed Practical Nurse
Licensed Nursing Ass't
TOTAL HOURS/EVENING

0

NIGHTSffiFT

a
a
a

Registered Nurse
Licensed Practical Nurse
Licensed Nursing Ass't

.TBS

TOTAL HOURSjNIGHT
TOTAL HOURS/WEEK
=:

To be scheduled

6

0
46

2.) Chittenden
~

POSITION

II
I~I~

=r

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

MON

J

TUE[WED

..

9
9
8
8
8
16
8

..

5
9
9

8

8
16
8

8
16
8

8
16
8

8
16
8
8
8
TOTAL HOURS/ VA Y

8
8
8

8
8
8
8
8
8
8
TOTAL HOURS/ EVENING

.

8
8
8

_

8

8

8

8

8

7

I

I

8

TOTAL HOURSjNIGHT
TOTAL HOURS/WEEK

= To be scheduled

~

10
18
18
20
40
0
40
96
56
298

40
56
56
152

•..

-_..

*Tss

8
8

[TB~' I ':~'

..

8
8
8

I!:GHT SHIFT
.

SUN

8

..

8
8
8

[

4
8

.•

Registered Nurse
ILicensed Practical Nurse
Licensed Nursing Ass't

FRI]~AT

8
8

EVENING SHIFT

IL-~··

I.

..

DAY SHIFT
5

.

,Registered Nurse / L P ,-.)
Licensed Practical Nurse
!Licensed Nursing Ass't

1 THU

8

0
56
0
56
506

3.) Dale
I

!

POSITION
..

[

]

.

MON]

TUE

[WED

[THU

[FRI

DAYSHfFT

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

I

SAT

I

SUN

I ~~II

[TBS*

6

8
8

4
8

8

8
8

8
8

II

.

6
0
0
8
24
0
40
72
0

4
8

8
8

8
8

16

16

150

TOTAL HOURS/ DA Y

.

EVENING SHIFT
..

Registered Nurse or LPN
Licensed Practical Nurse

.

8

8

8

8

8

8

56

8
limed
bed filled,
need 2nd
LPN

Licensed Nursing Ass't

0
TOTAL HOURSjEVENING

.

56
I

I

,INIGHT SHIFT

I - -

IRegistered Nurse

0

Licensed Practical Nurse

8

8

8

8

8

Licensed Nursing Ass't
,
.
= To be scheduled

8

56
0

TOTAL HOURS/ NIGHT
TOTAL HOURSjWEEK

I

.TBS

8

limed
bed filled,
need 2nd
LPN

.•

8

..

. .

56
262

4.) Marble Valley

CP~SITION

I MaN

THU

I

F~I

8

8
8

8

8

8

8

8

8

8

8

8

8

8

8

8

J

SAT I

sUN]

TB~' [~~ll
8
0
0
8
40
0
40

8

56

8

0
TOTAL HOURSjDAY

.

.~.

[

WED I

DAY SHIFT
8

Medical Director
Dentist
,Dental Assistant
IPhysician Assistant
'Program Manager
,Administrative Ass't
Registered Nurse
ILicensed Practical Nurse
(Filled bV RN as of2/1/05)
,Licensed Nursing Ass't

,,

I TUE ]

~

..

152

EVENING SHIFT
~

Registered Nurse
Licensed Practical Nurse
(Filled bV RN as 0(2/1/05)
Licensed Nursing Ass't

0

8

8

8

8

8

8

8

0
TOTAL HOURSjEVEN1NG

,

56

NIGHT SHIFT

a

IRegistered Nurse
I Licensed

Practical Nurse

8

8

8

8

8

8

8

I

56

a

ILicensed Nursing Ass't

L

56

TOTAL HOURSjN1GHT
TOTAL HOURSjWEEK
~
~

*T88 = To be scheduled

9

56
264

..

5.) Northern State
POSITION

MON

TUE

.•

..•

_...

.

WED

THU

8
8

8
8
8

8

8

DAY SHIFT
8
8
6
8
6
8
8
8

8

6

6

6

6

6

8
8

8

8
8

8

16

16

16

fl I .:

ILicensed Practical Nurse
ILicensed Nursing Ass't

8
8

TBS'

HRSI
WK

16
30
30
16
40
30
56
80

a
8
8

8
8

EVENING SHIFT
8
8
8
8

298

•.

8
8

56
56

TOTAL HOURSjEVENING

112
.

8
8

8
8

a

,

NIGHTSH/FT

.

Registered Nurse
Licensed Practical Nurse
(Filled b1{ RN as of 2/1/05)
Licensed Nursing Ass't

8
8

TOTAL HOURSjDAY

..

,I

SUN

8

8

I~

II

SAT

.•.

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

IRegistered Nurse.l.

FRI

a
8

8

8

8

8

8

8

56

a
TOTAL HOURSjNIGHT
TOTAL HOURS/WEEK
..

..

*TBS = To be scheduled

10

56
466

6.)
Northeast R..
..

.
"
POSITION

l

.

MON

[T~E

[ WED]

THU

[

F~IISAT·I

SUN

DAY SHIFT

..

6

6

8

8

8

8

8

8

8

8

8

8

8

8

8

8

8

I

I

HRSI
WK
~I

6
0
0
12
40
0
40

6

Medical Director
Dentist
Dental Assistant
Physician Assistant
Program Manager
Administrative Ass't
'Registered Nurse
Licensed Practical Nurse
(Filled by RN M-F (40 Itrs) as of

j

[TSS-

8

8

56

2/1/05)
0
154

Licensed Nursing Ass't
TOTAL HOURSjDAY

II

EVENING SHIFT

-I

0

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

16

16

16

16

16

16

16

112
0

..

TOTAL HOURSjEVENING

-

NIGHT SHIFT

I,

._.

IRegistered Nurse

ILicensed Practical Nurse

8

8

8

8

8

8

8

Licensed Nursing Ass't
TOTAL HOURS/-NIGHT
TOTAL HOURS/WEEK

.

*TBS = To be scheduled

I1

112

.

0
56
0
56
322

7.) Northwest State

[

.

POSITION

[

~~

TU.E

[WED

I

THU.

DAYSH/FT

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

9
9

SAT

J

SUN

I

T8S'
.

D:~I I
I
I

8
9
9

[FRI I
8

16
18
18
12
40
0
40

8

6
8

8

6
8

8

8
8

8
8

8
8

8
8

8
8

8

8

56
0

I

TOTAL HOURSjDA Y -..-

II

..

200

IIEVENING SHIFT
,
~.

.

Registered Nurse
;> i
Licensed Practical Nurse
Licensed Nursing Ass't

0

16

16

16

16

16

16

112
0

TOTAL
HOURSjEVENING
•.

.

1-··

I

..

112

NIGHT SHIFT

IRegist~red Nurse

.
Licensed Practical Nurse
ILicensed Nursing Ass't

0

8

8

8

8

8

•..

8

8

56
0

TOTAL HOURSjNIGHT
TOTAL IIOURS/WEEK

I

L....

16

..

*TBS = To be scheduled

12

56
368

8.) Southeast State
POSITION
._...

. .

ry~N [~UE [~:roTTHU
4

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

HRSI
WK

TBS*

4

6

0
0
12
24
0
40
40
0
124

6

8
8
8

8

8
8

8

8

8

8
8

8
8

8

TOTAL HC?URSjDAY

..

EVENING SHIFT

IR~gistered Nurse
Licensed Practical Nurse
,Licensed Nursing Ass't

SUN

DAY SHIFT

IL...-...

L

[F~SA~

8

8

8

I

8

--_...

8

8

8

TOTAL HOURS/EVENING

•.

I

._.-

..

0
56
0
56
i

NIGHT SHIFT
.

'Registered Nurse
Licensed Practical Nurse
Licensed Nursing Ass't

8

8

8

8

!
8

8

TOTAL HOURSjNIGHT
TOTAL HOURS/WEEK

L .
*TBS = To be scheduled

13

8

_.....

~~

..-

0
56
0
56
236

9.) Southern State

.

I M~;rTUE

POSITION
I
1[.

..

r

WED

[

THU

I

FRI

[SA~

..•

SUN

TBS*

HRSI
WK

DAY SHIFT

IMedical Director

4
8
8
8
8
16
16
24
8
8

,Dentist
IDental Assistant
Nurse Practitioner
IProgram Manager
IMedical Records Clerk
Registered Nurse
Licensed Practical Nurse
Licensed Nursing Ass't
RN - Infirmary

C·

I;;GH~SHIFT

-_..

~

4
6
6

4

8
8
16
16
24
8
8

8
16
16
24
8
8

8
16
8
8

8
16
8
8

TOTAL HOURSjDAY

.

.

20
30
30
24
40
80
96
152
56
56
584

EVENING SHIFT

8
16
8
8
•..

•.

8
16
8
8

8
16
8
8

8
16
8
8

8
16
8
8

8
16
8
8

8
16
8
8

TOTAL HOURSjEVENING

.

_...

8
8

8
8

8
8

8
8

8
8

8
8

8
8

8

8

8

8

8

8

8

TOTAL HOURSjNIGHT
TOTAL HOURS/WEEK ..

..•

*TBS ::::: To be scheduled

14

I

II

56
112
56
56
280

.

IRegistered Nurse
Licensed Practical Nurse
Licensed Nursing Ass't
RN - Infirmary!' .!) II
•.

4
8
8
8
8
16
16
24
8
8

8
16
16
24
8
8

...

Registered Nurse
ILicensed Practical Nurse
Licensed Nursing Ass't
RN -Infirmary ILl'!)

..

4
8
8

56
56
0
56
168
1032

II
II

Attachment K

Staffing Coverage Standards
Shift

D_ay

I

Caledonia I Chittenden I
Dale
I Marble Valley I Northern State
Title IHonrs/ Title Hours Title Hours/ Title Hours Title Hours
I Week
/Week
Week
/Week
/Wee

-~~ +~~ -~£-t--:o
--i----r---.-..l=-! = t~~t~rl--~~ F4~

If--- ..... -'-------.~
Evening

.__...

4~~;~F

k

~~! :0 --.. ~~

_@Nl-56.=-

. .__.. _._..... __._--.L_

i
.--! -

j::PN'56
LPNTs6-- LPN
.-. LNAI56-1----·-_'i--

1--+--1-

.

I

i ~

r~--

Northwest
State
Title iHours/
. Week

Southeast
State
Title Hours/
Week

.--.. -,---.--.

.

p~L-~~~
!Zl:'J+_.!l~

LPNj-56

:=L_.

I

LPN -E56

-LPN

i-40

_

=~-~- ~.:n ~.

I

i i iI

__ ~ _ _.___
LPN .+_56
LPI\

---1··---

~i

-.- .-.---,---- -,------1

_~~~~r~~.~--l=~f-.--l~
-.-----r--.

Southern State
Title
Hours/
Week

. . Rli.-j_-±'O__
.

I--f--,..- J:P~__
·-1
L--·

N~;~FI

~~...... ~+--~~

-.- r·--~-I-

--.-..J
.--""---,-RNl
40
RN/ I 56
I

LPN !

Northeast
Regional
Title iHours/
Week

---I

I

RN2

56

RNInfirm

56

RN'

I

56

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~ t" •. 'f~ U'N+"'--irn+'
UN

-~

:LfN :..:" -

U'N] ..:,

'-""4 "-- -_U'N t "
--- -

_ - - _..

The above matrix reflects Contractor's Staffing Matrix (Attachment H) for PAs, NPs, RNs, LPNs and LNAs. The intent of Attachment K is to provide a definition
of an uncovered shift for purposes of determining the staffing penalties deseribed in Attachment A. For highlighted positions, Contractor will be in compliance if
only one (I) of two (2) scheduled individuals of the same title is 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 -. eharging the DOC at the
cost ofthe regularly scheduled health profession - without penalty.

A permanent evening RN position is expected; in the event an RN cannot be found to fill the position, an LPN may fill the position without risk of penairy (CRCF, DSCF, NSCF).
2

Two evening/night RNs are preferred; in the event two RNs cannot be found, an LPN may fill ONE position without risk of penalty (SSCF).
15