Chapter 5 – Administrative

Policy

• The California Correctional Health Care Services (CCHCS) or the California Prison Health Care Receivership Corporation (CPR) may solicit providers of, and award contracts for goods and/or services in accordance with the June 4, 2007 Federal Court Order Waiving State Contracting Statutes, Regulations and Procedures (“Federal Court Waiver”), and the alternative contracting procedures (“Alternative Contracting Procedures”) approved therein.

Responsibility

• The Director, Health Care Policy and Administration, CCHCS shall ensure compliance with this procedure.

Procedure

• Contracting units within CCHCS and CPR may seek guidance to award contracts under the Federal Court Waiver using the Alternative Contracting Procedures for those contracts within the scope of the Federal Court Waiver. Generally, such guidance should be sought where time is of the essence and use of standard state contracting procedures would delay or prevent delivery of essential goods and/or services.

• Documentation and Checklist:

  • For each contract processed under the Alternative Contracting Procedure, the contracting unit shall create and maintain a Contract File containing the key documents identified in this procedure in hard copy. It is not necessary for the Contract File described in this procedure to be separate from the Standard Contract File otherwise maintained by the contracting unit.

  • The “Federal Court Waiver Contract Checklist” shall be completed by contracting units and submitted with each final contract approval package. A copy of the Federal Court Waiver Checklist shall be maintained in the Contract File.

  • The scope of this procedure is limited to complying with the requirements of the Federal Court Waiver. Other document retention practices may apply as required by other departmental procedures.

• Determining if the Federal Court Waiver Applies:

  • As of the approval date of this procedure, the Federal Court has authorized the use of the Alternative Contracting Procedure for certain projects, including, but not limited to: information technology technical and operational infrastructure, health information management, telemedicine, recruitment and hiring, pharmacy, radiology services, laboratory services, credentialing, nursing leadership development, and asthma care.

  • Project area waiver limits can be located in the following location: https://cchcs.ca.gov/reports/. No plans to use the Alternative Contracting Procedure should proceed without the consultation and prior approval of the CCHCS Office of Legal Affairs (COLA). For the purpose of this procedure, the term “COLA” includes designated outside counsel.

• Requesting Approval to Use the Alternative Contracting Procedure:

  • Contracting units planning to use the Alternative Contracting Procedure for a contract shall obtain the prior written approval of COLA, which shall:

  • Identify the appropriate waiver project area.

  • Identify the specific alternative process to be used (e.g., Expedited Formal, Urgent Informal, or Sole Source).

  • Be maintained by the contracting unit in the Contract File.

• Soliciting a Contractor:

  • The Federal Court Waiver establishes an Alternative Contracting Procedure allowing the solicitation of contractors using one of three following processes:

  • Expedited Formal Process

    • Applicability

      • The Expedited Formal process shall be used for all higher cost contracts (e.g., contracts whose total contract price is estimated to be valued at $750,000 or more).

      • The Expedited Formal process also presumptively applies to contracts whose total contract price is estimated to be valued at $75,000 – $750,000, unless it is determined that urgent circumstances require use of the Urgent Informal process.

    • Procedure

      • Contracting units shall develop a Request for Proposal (RFP) or similar solicitation (e.g., Request for Qualifications or Request for Bids) for the desired goods and/or services. The prior written approval of COLA shall be obtained prior to issuing the RFP or similar solicitation.

      • Contracting units shall publish the RFP for a period of at least seven calendar days and retain evidence of all publications in the Contract File. RFPs shall be published on the CCHCS website and in a trade publication of general circulation and/or an internet-based public RFP clearinghouse (e.g., https://cchcs.ca.gov/project_rfp/). In addition, contracting units may send the RFP directly to potential contractors.

      • The contracting unit shall notify COLA, and COLA shall notify the parties in Plata v Newsom that the RFP has been published. The notice sent to the Plata parties shall be copied to the contracting unit and maintained in the Contract File.

      • The response period for the RFP shall be a minimum of 30 calendar days. All responses shall be maintained by the contracting unit in the Contract File. If fewer than three potential contractors submit proposals, the contracting unit shall make reasonable, good faith efforts to identify additional bidders and solicit their responses to the RFP. Such efforts shall be documented and maintained in the Contract File.

      • The contracting unit shall establish a selection committee consisting of at least three persons, all of whom with relevant experience, none of whom are affiliated with or otherwise have any conflict of interest with, any bidder, or have any conflict of interest in participating in the selection committee generally. Contracting units shall obtain certifications from the committee members to that effect and maintain the certification in the Contract File. The “Conflict of Interest Certification for Contractor Selection Committee Members” form shall be used for this purpose.

      • Criteria for selection of the recommended bidder may be set forth in the RFP and otherwise may, in the reasonable determination of the selection committee, including, but not limited to:

        • Cost factors;

        • Reputation of the bidder for responsiveness and timeliness of performance;

        • Quality of service or product performance;

        • Ability of the bidder to provide innovative methods for service delivery; and

        • Other similar factors the selection committee deems relevant.

      • The selection committee may conduct interviews of some or all of the bidders, may respond to questions posed by bidders, and provide additional information to bidders. For contracts whose total contract price is estimated to be valued at $750,000 or more, the selection committee shall conduct interviews of at least the top two bidders.

      • The selection committee, via the contracting unit, shall provide the Receiver or designee a written recommendation regarding the proposed contractor. The recommendation shall include an explanation of the basis for the recommendation. The selection recommendation may be submitted prior to or concurrent with the submission of the final contract for approval. A copy of the recommendation shall be maintained in the Contract File.

  • Urgent Informal Process

    • Applicability

      • The Urgent Informal process is designed to provide contracting units with the flexibility to move more quickly than permitted by the Expedited Formal process when urgent circumstances required. Nonetheless, it still requires a competitive bidding process to the extent possible.

      • Contract units may utilize the Urgent Informal bidding process for contracts whose total contract price is estimated to be valued at $75,000 – $750,000 if it is determined that urgent circumstances do not permit sufficient time to utilize the Expedited Formal bidding process because:

        • The additional delay that would result from utilizing the Expedited Formal process would substantially risk endangering the health or safety of incarcerated persons or staff, or

        • The contract is essential to the “critical path” of a larger project and the additional delay that would result from utilizing the Expedited Formal process would significantly interfere with timely or cost-effective completion of the larger project.

      • The Urgent Informal process may also be used for any contract whose total contract price is reasonably estimated to be valued at less than $75,000.

      • As set forth above, contracting units shall consult with COLA in determining if the use of the Urgent Informal process is appropriate.

    • Procedure

      • Contracting units shall make reasonable, good faith efforts to identify and solicit at least three proposals and will accept additional unsolicited bids that may be submitted, contracting units shall document all potential contractors solicited in the Contract File.

      • Contracting units may, at their discretion, develop an RFP prior to soliciting bidders, establish a response period with respect to any such RFP, and/or establish a selection committee to assist in the selection of the recommended bidder. Any written solicitation shall be maintained in the Contract File.

      • All responses, including verbal responses, shall be documented and maintained in the Contract File.

      • Criteria for selection of the recommended bidder, in the reasonable determination of the contracting unit, may include, but will not be limited to, cost, reputation of the bidder for responsiveness and timeliness of performance, quality of service or product performance, ability of the bidder to provide innovative methods for service delivery, and other similar factors the contracting unit deems relevant.

      • The contracting unit shall provide a written recommendation regarding the selection of the contractor to the Receiver, or designee, explaining the basis for the recommendation. The recommendation may be submitted prior to or concurrent with the submission of the final contract for approval. A copy of the recommendation shall be maintained in the Contract File.

  • Sole Source Process

    • Applicability

      • The Sole Source process is designed to permit contracting units to utilize a sole source when it is determined, after reasonable efforts under the circumstances, that there is no other reasonably available source.

      • The Sole Source process shall only be used as a last resort.

      • As set forth above, contracting units shall consult with COLA in determining if the award of a sole source contract is appropriate.

    • Procedure

      • The contracting unit shall document the efforts made to identity potential contractors and maintain the documentation in the Contract File.

      • The contracting unit shall provide a written recommendation regarding the proposed sole source award to the Receiver, or designee, explaining the basis for the recommendation. The recommendation may be submitted prior to or concurrent with the submission of the final contract for approval. A copy of the recommendation shall be maintained in the Contract File.

• Contract Preparation

  • Proposed contracts using the Alternative Contracting Procedure shall be submitted by the contracting unit to COLA for review and written approval as to form and legality, prior to submission of the contract to the Receiver or designee for final approval.

  • Contracting units shall maintain the written approval of COLA in the Contract File.

• Final Contract Routing & Contract Numbers

  • Contracting units shall route contracts processed under the Federal Court Waiver for final approval through the Receiver’s Custodian of Records. All final approval packages shall include:

    • A routing slip or transmittal letter including all necessary departmental approvals;

    • A recommendation for approval, including the contractor selection recommendation if not previously submitted (this may be included in the transmittal letter);

    • An original contract for signature; and

    • A copy of the completed Federal Court Waiver Contract Checklist.

  • The Receiver’s Custodian of Records shall maintain a log of all contracts executed by the California Department of Corrections and Rehabilitation (CDCR) or CPR under the Federal Court Waiver. After a contract is executed by the Receiver, or designee, the contract shall be returned to the Custodian of Records who shall log the CDCR agreement number, or assign and log a CPR contract number.

  • The Receiver’s Custodian of Records shall maintain original executed CPR contracts and copies of executed CDCR contracts (returning CDCR originals to the applicable contracting unit) in a central contract file. In addition, the Receiver’s Custodian of Records shall maintain all final approval packages, including the Federal Court Waiver Contract Checklist, in the central contract file. All original source documents identified in the Federal Court Waiver Contracts Checklist shall be maintained by the contracting unit in the unit’s Contract File.

• Reporting

  • The Receiver’s Custodian of Records, in consultation with COLA and the applicable contracting unit as needed, shall be responsible for preparing the contracting report for inclusion in the Receiver’s Tri-Annual Report to the Court. The reports shall include a summary that:

  • Specifies each contract awarded during the quarter;

  • Provides a brief description of each such contract;

  • Identifies which of the projects or categories of projects the contract pertains to;

  • Identifies the method used to award the contract (e.g., Expedited Formal, Urgent Informal, or Sole Source);

  • Lists all bidders for each contract, identifies which bidders were solicited directly, and identifies  the successful bidder;

  • Notes if fewer than three bidders responded to a solicitation;

  • Explains the determination that one (or both) of the criteria for using the Urgent Informal process were satisfied for contracts using the Urgent Informal process whose total contract price is estimated to be between $75,000 – $750,000; and,

  • Explains the basis for determining that no other sources were reasonably available for contracts that are sole-sourced.

• Approval and Review

  • The CCHCS Director of Health Care Policy and Administration and the COLA Chief Counsel shall review this procedure annually.

Policy

• California Correctional Health Care Services (CCHCS) contracts with a Prison Health Care Provider Network (PHCPN) contractor to provide a network of specialty physicians, hospitals, ambulances, and other health care service providers. Upon approval by CCHCS Direct Care Contracts Section (DCCS) Headquarters Management (HQM), the PHCPN contractor shall make network-related information available to designated personnel, as determined by each institution, with a need to access information via a web portal.

• The web portal includes a Provider Directory and Information Warehouse. The Provider Directory houses the Provider Network and shall be utilized to canvass for current and active participating health care service providers within the PHCPN to meet patient health care service needs. The Information Warehouse contains information on health care utilization and the provider network’s performance for oversight and reporting. Designated personnel on the PHCPN Web Portal shall be granted access to the Provider Directory and/or the Information Warehouse, once the request has been approved by DCCS HQM.

Procedure

• Web Portal Access

  • Users requesting access to the PHCPN Web Portal shall submit a DCCS Training Request Form to register for the Health Net Provider Directory training provided by Specialty Network Administration Program (SNAP). The DCCS Training Request Form is available on CCHCS Lifeline under “Direct Care Contracts,” “Quick Links” tab or at the following link: DCCS-TRNG-REQ-Form Rev 08.07.24.pdf.

  • At the time of training, instructions shall be provided on how to complete the Health Net Federal Services CCHCS – Access Request Form – Authorized User Form (herein referred to as Health Net Access Request Form). The user shall complete the Health Net Access Request Form, available on CCHCS Lifeline under “Direct Care Contracts,” “Resources,” “Forms” tab, “Health Care Provider Network” or at the following link: HealthNet-AccessRequestForm.pdf.

  • The Chief Executive Officer (CEO), Chief Medical Executive, Chief Nurse Executive, Chief Support Executive, or designee, shall electronically sign the form to approve the request. Their signature approves that the user’s initial profile can be created, modified, or deleted upon separation of duties. The user shall submit the approved form to the following SNAP inbox: snap@cdcr.ca.gov.

  • SNAP shall route the Health Net Access Request Form to DCCS HQM, or designee, who shall then review and approve, if necessary, sign each Health Net Access Request Form. DCCS HQM shall return the signed Health Net Access Request Form to SNAP for processing.

  • SNAP shall email the requestor indicating approval or denial of the request. If approved, the email notifies the user that their profile has been created and how to login to the Provider Network Web Portal Maintenance.

• Provider Directory Usage

  • PHCPN Web Portal users who utilize the Provider Directory shall:

  • Canvass the PHCPN Provider Directory Tier 1 and Tier 2 service providers using the ProviderSearch tool. The ProviderSearch tool utilizes four available criteria: location type (address/radius, city, county, or state); provider name: provider identification number: or license number. The search shall be narrowed by plan/network type; and specialty and subspecialty.

    • Tier 1 and Tier 2 provider information are available based on access granted. Tier 1 providers are the preferred choice and shall be utilized first, if available, unless there is a health care need to send the patient to a Tier 2 provider.

    • Written approval (e-mail is acceptable) shall be obtained from the institution CEO, or designee if a Tier 2 service provider is selected. Approvals shall be sent to the SNAP inbox: snap@cdcr.ca.gov.

  • Contact SNAP for further direction if no available resources are found, or if the available resources are unable to fulfill a health care service need through the PHCPN Provider Directory.

Policy

• The California Correctional Health Care Services (CCHCS) Medical Registry Network (MRN) and the Dental and Mental Health Registry Network (DMHRN) contractor(s) will make network-related information available, including provider utilization and timekeeping, to the California Department of Corrections and Rehabilitation (CDCR) and CCHCS via the Registry Workforce Management System (RWMS).

Procedure

• Initial Access Request

  • CCHCS Direct Care Contracts Section (DCCS) Section Support Team (SST) is responsible for facilitating access to the RWMS for designated CDCR/CCHCS staff.  SST will notify the network contractor to authorize access to the system upon staff submission and completion of the proper forms and training as follows:

  • The CCHCS-MC-425 Registry Workforce Management System (Stafferlink) User Request & Confidentiality Statement which can be found on Lifeline under “Direct Care Contracts,” “Resources,” “Forms” tab, “Registry Networks,” or Direct Care Contracts – CCHCS-MC-425 Registry Networks Vendor Workforce Management System (Stafferlink) User Request & Confidentiality Statement.

  • The DCCS Training Request Form which is available on Lifeline under “Direct Care Contracts,” “Quick Links,” or DCCS-TRNG-REQ-Form.pdf.

  • The forms shall be submitted to the user’s manager or supervisor for review and approval.

  • The user’s manager or supervisor shall review, approve, and submit the forms to CCHCS DCCS Help Desk via e-mail at: CCHCSHealthcareContractsHelpDesk@cdcr.ca.gov.

  • Upon receipt, DCCS Help Desk staff shall route the form(s) to the SST training team for review and approval. SST training team shall retain approved forms for at least three years from the date of approval.

  • The SST training team shall enroll the user in the required RWMS training and submit the CCHCS-MC-425 form via e-mail to the Vendor Web Portal Administrator for action.

  • The Vendor Web Portal Administrator shall create the user profile and send an e-mail to the SST training team to confirm action taken.

  • The SST training team shall send RWMS login information to the user.

• Request to Modify or Delete User Access

  • A request to modify or delete approved user access shall be made upon separation of staff from CDCR/CCHCS, when user access is no longer required or access requires adjustment.

  • Request to Modify User Access

    • The user shall complete the CCHCS-MC-425 (Refer to Section III.A.1.) and submit the form to their manager or supervisor for review and approval.

    • The user’s manager or supervisor shall review, approve, and submit the form to CCHCS DCCS Help Desk via e-mail at: CCHCSHealthcareContractsHelpDesk@cdcr.ca.gov.

    • Upon receipt, DCCS Help Desk staff shall route the form(s) to the SST training team for review and approval.

  • Request to Delete User Access

    • The user’s manager or supervisor shall initiate the request by selecting “Discontinue User” on a CCHCS-MC-425 form (Refer to Section III.A.1.) and submit the form to CCHCS DCCS Help Desk via e-mail at CCHCSHealthcareContractsHelpDesk@cdcr.ca.gov.

  • Upon receipt, DCCS Help Desk staff shall route the form to the SST training team. SST training team shall retain approved forms for at least three years from the date of approval.

  • The SST training team shall submit the form via e-mail to the Vendor Web Portal Administrator for action.

  • The Vendor Web Portal Administrator shall modify or delete the user profile as indicated and send an e-mail to SST training team to confirm action taken.

• RWMS Usage

  • CDCR/CCHCS staff shall use the RWMS to:

    • Submit and review requests for registry providers.

    • Review registry provider profiles, credentials, and compliance.

    • Review and approve completed registry provider timecards.

    • Generate reports.

    • Provide updates, issues, or concerns to the registry network contractor.

  • For access, navigation, and retrieval of registry reports, refer to the user security group training materials provided by the registry network contractor which are available on Lifeline under “Direct Care Contracts,” “Networks,” “Medical Registry Network” tab, “Training Materials,” or at the following link: Resources (sharepoint.com).

    • The following documents shall be included:

    • Stafferlink Reference Guide-Institution/Facility Staff.

    • Stafferlink Reference Guide-Credentialing.

    • Stafferlink Reference Guide-Institution/Facility Management.

    • Stafferlink Reference Guide-Healthcare Invoicing Section.

    • Stafferlink Reference Guide-Headquarters.

• Timekeeping

  • Within each institution/facility, the unit manager or supervisor shall designate the following:

    • A specific location(s) to maintain the DMHRN and MRN timecards for registry providers to sign in and out each day for hours worked.

    • At least one point of contact for the medical, dental, and mental health programs to assist the DMHRN and MRN contractor with obtaining CDCR/CCHCS authorized manager or supervisor signatures on timecards.

  • The unit manager or supervisor shall ensure the following:

    • The DMHRN or MRN registry provider(s) sign in and out on a daily basis in the designed areas.

    • All DMHRN and MRN registry provider(s) obtain a CDCR/CCHCS authorized manager or supervisor signature on the timecard for all regular hours worked, as well as a daily signature for any unanticipated on-call or callback hours worked on any given day.

    • All copies of the prior week’s timecards with the appropriate activation report completed are emailed to the DMHRN or MRN contractor each Monday by close of business at: timekeeping@vmssolution.com.

    • All timecard discrepancies are resolved in collaboration with the DMHRN or MRN contractor.

  • The following timesheet reference materials are available on Lifeline under the “Direct Care Contracts,” “Networks,” “Medical Registry Network” tab, or at the following link: Resources (sharepoint.com).

    • Sample Timesheet – Available under “Directives and Procedures.”

    • Timesheet User Guide – Available under “Directives and Procedures.”

    • MRN-DMHRN Timekeeping Process – Available under “Training Materials”.

Policy

• The California Department of Corrections and Rehabilitation/California Correctional Health Care Services (CDCR, CCHCS) staff shall collaborate with a network contractor to develop and maintain a statewide Medical Registry Network and/or Dental and Mental Health Registry Network comprised of registry providers available to deliver temporary/relief medical, dental, and mental health care services to patients housed at CDCR institutions and facilities.

Procedure

• Contract and Payment Rate Information

  • Contract information and payment rates shall be maintained as confidential between the contracting state entity and the network contractor.  Releasing this information to temporary/relief registry providers working at the institution/facility or network vendors could result in potential breach of contract or legal actions brought by the network contractor. Institution/facility staff shall:

  • Not discuss or release any contract information, including payment rates, with temporary/relief registry providers.

  • Inform temporary/relief registry providers that they must contact their network contractor or the network vendor about contract information and payment rates if they inquire.

• Temporary/Relief Registry Providers Time Off and Work Schedule Changes

  • Approval for time off or schedule changes are granted only by the network vendor. The network contractor is responsible for coordinating any approved time off or schedule changes with the institution/facility staff and Direct Care Contract Section (DCCS) to ensure continued staffing coverage.  Institution/facility staff shall:

  • Refer the temporary/relief registry providers to their network vendor for time off or work schedule change approval.

  • Immediately notify the assigned DCCS analyst via email and document in the Registry Workforce Management System when approached by temporary/relief registry providers for time off or schedule changes.  DCCS shall coordinate with the network contractor and the institution/facility to ensure continued coverage is maintained and to request that the network vendor counsel the temporary/relief registry providers regarding the process for requesting schedule changes.

• Holiday Pay Rates for Temporary/Relief Registry Providers

  • Holiday pay is allowed only when included in the contract and for the specific temporary/relief registry classifications listed under the allowance in the contract.

  • Authorization from the institution Chief Executive Officer (CEO)/Chief of Mental Health (CMH)/Chief Medical Executive (CME)/Supervising Dentist (SD)/Division of Juvenile Justice (DJJ)/Associate Director (AD) or respective designee is required to receive holiday pay.

  • If holiday pay is allowed, pay will commence on the first shift work hours before the holiday through the third shift work hours of the actual holiday.

  • The temporary/relief registry provider timecard is reviewed and authorized by the CEO, CME or respective designee as required to receive holiday pay.

  • If temporary/relief registry providers have questions about holiday or overtime pay, or any timekeeping/related topics, they shall be directed to their network vendor.

• Temporary/Relief Registry Providers Disciplinary Process

  • Temporary/relief registry providers are not subject to the same Human Resources policies or procedures as civil service employees; therefore, institution/facility staff shall not pursue progressive discipline or provide an appeal process to temporary/relief registry providers who have been disciplined. However, temporary/relief registry providers working on-site at the institution/facility are required to adhere to all CDCR, CCHCS patient care and security policies and procedures.

  • Institution/facility staff shall report violations of CDCR, CCHCS patient care and security policies and procedures by temporary/relief registry providers to the network contractor by documenting in the Registry Workforce Management System.

  • Institution/facility staff shall also contact the DCCS Help Desk by e-mail at CCHCSHealthcareContractsHelpdesk@cdcr.ca.gov, or by telephone at (916) 691‑0698.

  • DCCS will work with the network contractor and institution/facility staff to resolve issues in accordance with contract requirements.

  • In cases of egregious performances that warrant removing a contractor and/or temporary/relief registry provider from an institution/facility, the institution/facility or Headquarters staff shall contact the DCCS Help Desk immediately upon removal by telephone or e-mail for instructions on how to proceed.

  • As a temporary measure and while pending a response from the DCCS Help Desk, institution/facility leadership may require temporary/relief registry providers to leave the institution/facility grounds immediately and revoke their access to the institution/facility by recovering their state ID badge and chits if their continued presence poses a safety and/or security risk to the institution/facility, other staff members, or patients.

Policy

• California Correctional Health Care Services (CCHCS) participates in the Statewide Pharmaceutical Program, also referred to as the Prescription Drug Bulk Purchasing Program, established by Government Code sections 14977-14982, and administered by the Department of General Services (DGS).

Applicability

• This policy applies to all CCHCS staff involved with acquisitions of pharmaceutical products.

Procedure

• Pharmaceutical acquisitions shall be made utilizing pre-existing sources and other acquisition processes according to the following guidelines:

• Prescription bulk pharmaceuticals shall be purchased using the mandatory Pharmaceutical Wholesaler statewide contract.

• Pharmaceutical products not available through the Pharmaceutical Wholesaler statewide contract shall be purchased using mandatory DGS contracts, when available.

• Pharmaceutical products not included in a DGS contract may be obtained by following standard acquisition procedures (Refer to the CCHCS Acquisitions Customer Guide).

• For pharmaceutical acquisition requests that meet blanket purchase order requirements as specified in the CCHCS Acquisitions Customer Guide, Section 3.4, the procedures contained within the guide shall be followed.  Otherwise, pharmaceutical acquisitions shall follow standard procedures as found in the Acquisitions Customer Guide.

Policy

• California Department of Corrections and Rehabilitation (CDCR) and California Correctional Health Care Services (CCHCS) staff shall document and report, in writing, any performance issues concerning a direct health care service contractor and/or provider to the Direct Care Contracts Section (DCCS).

Procedure

• Institution or HQ Staff Responsibilities

  • Institution and HQ staff shall report all contractor and/or provider reportable performance issue(s) by:

    • Utilizing the forms available on Lifeline at the following link: Resources (sharepoint.com) to report identified issues.

      • For non-network provider issues, document the unsatisfactory contractor and/or provider performance issue using the CCHCS-MC-411, Direct Health Care Service Contractor and/or Provider Incident Report available at the following link: CCHCS-MC-411.docx (sharepoint.com).

      • For in-network provider performance issues, utilize the Healthcare Provider Network (HPN) Potential Quality Issue (PQI) Referral Form available at the following link: Direct Care Contracts – Healthcare Provider Network (HPN) Potential Quality Issue (PQI) Referral Form – All Documents (sharepoint.com).

    • Notifying the CCHCS DCCS Help Desk (herein referred to as Help Desk) by e-mailing the completed CCHCS-MC-411 and/or HPN PQI Referral Form to: CCHCSHealthcareContractsHelpdesk@cdcr.ca.gov.

  • Institution and HQ staff may contact the Help Desk with questions about direct health care services contract terms or performance requirements via e-mail, or by telephone at (916) 691-0698.

• DCCS Staff Responsibilities

  • The Help Desk staff shall:

    • Acknowledge receipt of all e-mails received through the Help Desk inbox and inform the submitting party that Specialty Network Administration Program (SNAP) staff will respond within three business days.

    • Notify SNAP via SNAP@cdcr.ca.gov following the receipt of the performance issue and forward the CCHCS-MC-411 and/or HPN PQI Referral Form and all relevant documents to SNAP within one business day.

    • Log and assign a tracking number to all inquiries related to contractor and/or provider reportable performance, and monitor the status of each inquiry.

  • SNAP staff shall:

    • Maintain a listing of incident reports/issues, monitor the status, and track all forms and related documents received from the Help Desk.

    • Communicate with the submitting party for further details/completion of the forms if the forms do not indicate enough details to fully address the incident/issue.

    • Review and determine a recommendation for an appropriate course of action for each performance issue received. If the issue is determined to be a critical incident, all forms and related documents shall be forwarded to DCCS Management.

  • DCCS Management shall:

    • Review and assess the incident report.  If the issue is deemed a clinical issue, forward all forms and related documents to Utilization Management (UM) leadership.

    • Follow-up with UM and assess whether a corrective action plan is required.

  • UM shall:

    • Review all forms and related documents of the incident.

    • Notify Health Net if a corrective action plan is needed.

• Unsatisfactory Contractor and/or Provider Performance Monitoring

  • DCCS and/or UM shall follow-up with the institution, as needed, to confirm the contractor and/or provider’s on-going performance is acceptable.

    • If performance remains unsatisfactory and compliance does not occur within the specified timeline in the corrective action plan, DCCS Management may provide the contractor with a Notice of Stop Work, Notice of Contract Suspension, Notification of Breach of Contract, or Notice of Termination Agreement.

    • A Notification of Breach of Contract, Notice of Stop Work, or Notice of Contract Suspension shall be sent to the contractor when the contractor and/or provider fails to comply with the specified terms of the contract or corrective action plan.

      • A Notice to Stop Work or Notice of Contract Suspension may be issued to direct the contractor to suspend performance or stop performing services for a specified period of time.  This shall be the contractor and/or provider’s last opportunity to address the unsatisfactory performance and a timeframe in which to comply with contract terms shall be provided.  Cancellations, extensions, or modifications and timelines for each notice may vary based on contract language.

    • If performance remains unsatisfactory through the specified timeframe, a Notice of Termination Agreement may be issued. Contract termination with cause may be immediate, or without cause within 30 calendar days from date of Notice of Termination Agreement. However, timelines may vary based on contract language.

    • In the event of contract or provider termination, SNAP staff shall coordinate with the institution or HQ staff to determine if a new contract or provider is needed for the impacted service.

    • Unless and until a Notice of Termination Agreement is issued, the contractor and/or provider shall continue to provide health care services under the contract.

• Contractor and/or Provider Immediate Removal

  • In cases of egregious performances that warrant removing a contractor and/or provider from an institution, the institution or HQ staff shall contact the Help Desk immediately upon removal by telephone or e-mail for instructions on how to proceed.