STATE OF VERMONT CONTRACT SUMMARY AND CERTIFICATION - Form AA-14
Contract # 10962

..........:::ONTRACT INFORMATION:

Amendment # 1

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Agency/Department: AHS/Corrections
Business Unit: Correctional Services· Central
Contractor: Prison Health Services, Inc
Address: 105 Westpark Drive, Suite 200, Brentwood, TN 37027

FedcrallD or S5#: 23-2108853
Starting Date: 1/2912007

Vendor No: 182150

Ending Date: 1/3112009

Summary of contr~Cl or amendment: Inmate Health Services - Clarify language in contract

II.

FINANCIAl. INFORMATION
Maximum units under contract:

MaxImum S payable under contract: 524,364,367.00

If Renewal:[Prior Contract #]

This Amendment-S Change: SO.OO

Cum. Amendments- S Change: $_ _

Cum % Change: 0.00%%

Unit change: _ _

Prior S max: S 24,364,367,00

Prior units:

Ratc:S_ _

Prior Rate: $_ _

Source of Funds: General Fund IOt100%%

F"ederal _ _% Code

Approprialion(s) Dept Id #: 3480004010;

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Other ,"'und: _ _~%L

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III.

SUITABILITY OF PERSONAL SERVICES CONTRACT
Does this cOnlractor meet all 3 parts of the "ABC" definition of independent contractor?
(See Ilulletin 3.5) Ifnot, please indicate why this work is being arranged through a cOnlracl.
Is agency liable for income tax withholding or FICA?
DYes [2J No
Should contractor be paid on the state payroll?
DYes [2J No

[2J Yes D No

IV,
PUBtiC COMPETITION:
The agency has taken reasonable steps 10 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:
[2J Standard bid or RFP D Simplified bid
0 Sole Sourced
D Qualification Based Seleclion

v.
TVP ..: OF CONTRACT:
[8] Pcrson<ll Service
DConstruction

o CommodIty

o Architectural/Engineering

o Privatization··
eo Req"ires

DHR review

VI.
CON ""LleT OF INTER EST: I certify that no person able to control or influence award of this contract had a pecuniary interest in its award
or performance, cither personally or through a member of his or her household, family, or business:
DYes [8] No
Is there an "appearance" of a conflict of interest so that a reasonable person may conclude that this contr<lctor was scleCted for
Improper reasons? (If yes, explain)
VII.

PRIOR AI'PROVALS REQUIRED OR R":QUESTED
Contraci must be approved by the Attorney General under 3 VSA §311(a)(10).
I request the Attorney General to review this contract as to fonn;
No, already performed by in-house AAG or counsel:
(Initial)
DYes [2J No
Contraci must be approved by the CIO/Commissioner of OIl; for IT hardware/software/services and
Telecommunications over $150,000
Contract must be approved by the CMO; for Marketing services over $15,000
DYes [2J No
[2J Yes D No Contract must be approved by the Secretary of Administration.

[2J Yes D No
DYes [2J No

ylIJ.

AGENCY/OEI'ARTMENT HEAD C ..: RTIFI AnON· APPROVAL

I },m'(! made rcasO/wblc inquiry as 10 {he ace

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Dale

Date

CIO (imtial)

Date

CMO (initial)

Date

··Rcvicwed By Comm. DHR or DHR AAG

Date

Approval by Secretary of Administration

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DOC CONTRACT AMENOM ENT ROUTING SHEET

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CONTRACTOR: PHS

LOCATION: Central
PROPOSED ALLOCATION:

CONTRACT MAXIMUM AMOUNT: $24.364,367.00

CONTRACT TYPE: (Check only one) Accounting Services D; Consultation D; CSC D; DV D;
Education

0;

Film License

0;

Food Svc 0; Haircuts

0;

Housing

0;

IDAP

0;

Inmate Transport

0;

Investigator D; IT D; Medical~; MH D; Phones D; Sex orrD; Sub Abuse D; Training D; VOWP

0;

Other 0 if other checked please give short name _ _.

Service Provided: Group 0; Supervision 0; Consultation 0; Transitional Housing 0; Other~, if other
checked please give short description Medical Services to Inmates.
\Vhat is the purpose of this contract: Medical Services to Inmates.
Source of Funds: General Fund: 100%

Federal(Identify): _ _ Other(Identify): _ _

Amendment# 1 Contract # 10962
Contract Renewal: Yes

0

No

[2J If No, $_ _ where is funding coming from? _ _

!fRenewal, is there an increase: Yes

D

No

Division/Site Budget: Central Office

To Alan: ...

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TO COMMISSIONER:

D

lfYes, $_ _ where is funding coming from? _ _

Central Office Contracl Manager: Dr. Susan Wehry

APproved:Yes0'NoD

.;2.,J."olfJ~

Date:

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Received insuranc~le: D

Date back from Commissioner: "·~'2-o1

TO AAG:

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Date back from Legal: ;;l\';"lDlo,,\TOAHS:

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Date back from AHS:

PINK MAIL./

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:.'>/07/01

TO CONTRACTOR:~llI-07-,Date back from Contractor:

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MAIL

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FINAL TO AHS:_~M=g'"''''''''~''''''.LI",...~a''o><o,-71--

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FINAL TO CONTRACTOR:_''''~'~"'''1.0>.-...;
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CONTRACT NUMBER

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Copy of AA-14 to Contract Monitor:

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ADDED TO PSC SPREADSHEET:
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CONTRACT # 10962
CHANGE# 1

AMENDMENT
It is agreed by and between the State of Vermont, Department of Corrections (hereafter called "State") and Prison Health
Services, me of Brentwood, TN, Vermont (hereafter called "Contractor") that contract #10962 dated 1126/2007 betvveen
said State and Contractor is hereby amended as follows:

To change Page 1, 4. Contract Ternl, delete "with two options to renew for an additional one(1) year term by the state"
and replace with" with two options to renew for additional onc year terms",
Attachment A, Chapter II Services, Section G: Delete last line in section: "The Contractor shall include a detailed
description of its health improvement and disease prevention program in its CQI program description."

Attachment A, Chapler II Services, Section J, subsection a. Provider Payments: Paragraph one - delete last line as follows:
"The contractor will assist the state in the process of determining eligibility and proof of identity and citizenship."
Replace with: "Contractor is responsible for completing a Vennont Health Access Plan (VHAP) enrollment foml
for all inmates receiving inpatient hospital services who may be eligible for VHAP coverage. The Contractor
will submit the inmate's enrollment fonn to VHAP for a detennination of program eligibility. VHAP eligibility
detenninations may require proof of inmate identity and citizenship which shall be the responsibility of tile
Department of Corrections (DOC) to obtain and provide to the Contractor as part of the VHAP enrollment
process "
Attachment A, Chapter V. Administrative Services, Section M. Other Operational and Financial Data
Reporting: Paragraph one, delete language: "All arulUal reporting shall be according to the State's Fiscal Year
(July 1 to June 30). Most annual and quarterly reports are due from the Contractor and any subcontractors to the
DOC within forty-five (45) days after the end of each reporting period. Facility-specific operational and
financial reports must be submitted, as well as an aggregated report for the entire system."
Attachment B, Section 4. Reconciliation of Costs: Add the following language to paragraph three: "Unless the
State notifies Contractor otherwise within thirty (30) days of the State's receipt of a monthly report or a
quarterly reconciliation report, all costs reported therein will be deemed accepted by the State. The State
reserves the right to request an extension of the thirty (30) day period. Such a request for an extension shall not
be unreasonably denied by Contractor and the parties will agree on the specific time period of the extension."
Attachment G, Chittenden Staffing Chart: The original inaccurate chart was removed at the time of signature
by the contractor and replaced with a corrected chart. The corrected chart is in the original contract and will not
be attached to this amendment but will be considered as part of this amendment.

Additionally, it is hereby agreed and understood that this contract has no minimum amount. The Contractors' services
will be required on an "as needed" basis.
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 full force and effect.
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The effective date of this amendment is 01129/07.

APPROVED AS TO FORM

STATE OF VERMONT
AGENCY OF HUMAN SERVICES
DEPARTMENT OF CORRECTIO S

Robert
Date:---,hlf-.41~'-I-

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g9Jt4l1ri1i~~~th Services,
Si n

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(please PRINT Signature)
Address: 105 Wesrpark Drive, Suite 200
Brentwood, TN 37027

SS#/Fed [0#, 23li'l)$S
Date,
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0)
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,

APPROVED AS TO FORM

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