New Adams County Jail Health Contract Includes 7-Day Nursing Coverage and Dedicated Mental Health Hours
New Adams County Jail Health Care Contract Details Staffing, Costs and Medical Services
Records obtained by Quincy Current through a Freedom of Information Act request provide the first detailed look at the agreement with TK Health, which began providing inmate medical services at the Adams County Jail on Oct. 1.
QUINCY, Ill. Newly obtained public records detail how medical care will be provided at the Adams County Jail under a new agreement between Adams County and Turn Key Health Clinics LLC, doing business as TK Health.
Quincy Current requested the records after learning TK Health was beginning health care services at the jail as part of a new medical services partnership. The Adams County Sheriff’s Office responded Oct. 2 and provided the contract governing inmate health services.
The agreement took effect Oct. 1 and places TK Health in charge of supplying and coordinating the jail’s health care delivery system for inmates, subject to the limits and responsibilities outlined in the contract. The company’s responsibility generally begins when an inmate enters the custody of the Adams County Jail and ends upon release. Work release inmates are treated differently under the agreement and receive emergency care from the provider while at the facility.
The contract offers a detailed picture of staffing, mental health services, medication management, emergency coverage and the costs Adams County will assume under the arrangement.
For the first year, Adams County is scheduled to pay TK Health $687,393.14, or $57,282.76 per month.
The agreement is structured around an average daily jail population of up to 135 inmates. If the average daily population exceeds 135, the county is to pay an additional $1 per inmate per day. If that average remains above 135 for three consecutive months, the parties agree to renegotiate the contract terms in good faith.
The pricing schedule shows a 3.85% annual increase if the agreement continues in subsequent years.
Under the schedule provided to Quincy Current, costs would rise to $713,857.78 in year two, $741,341.30 in year three and $769,882.94 in year four.
Those figures represent the contract’s scheduled renewal pricing rather than a guaranteed four-year expenditure. The agreement calls for annual renewal by mutual satisfaction and concurrence, and it also contains provisions allowing either party to terminate the agreement.
The contract allows termination for convenience with at least 60 days’ written notice. It also includes a process for termination for cause when either party fails to meet its contractual obligations.
Nursing coverage seven days a week
The staffing schedule included with the agreement is based on an average daily population of 135 inmates and provides for approximately 139 health care staff hours per week, equal to about 3.48 full-time equivalent positions.
The largest portion of that coverage comes from nursing.
An RN floor nurse is scheduled for 12 hours each day, seven days a week, totaling 84 hours per week.
An RN administrator is scheduled for eight hours a day Monday through Friday, totaling 40 hours per week.
The agreement also provides for a medical provider, identified as a physician, doctor of osteopathic medicine, nurse practitioner or physician assistant, for up to four hours each week. Psychiatric services are allotted up to three hours weekly, while a licensed mental health counselor is allotted up to eight hours each week.
The contract notes that actual clinic days may change to accommodate the jail and provider workflow.
Although the staffing schedule does not show a physician physically present at the jail around the clock, TK Health is required to provide access to a physician or midlevel medical provider for emergency consultation 24 hours a day, seven days a week.
The contract also requires health care personnel to perform inmate intake screenings, identify inmates with significant health concerns for follow-up care, administer prescribed medications, conduct sick-call triage and respond to medical needs and emergencies during regularly scheduled hours.
Physician and midlevel provider clinics are expected to occur in person at the jail when reasonably possible. The agreement permits telemedicine when an in-person clinic is not practical because of provider scheduling or availability.
Mental health included in staffing plan
Mental health care is specifically included in the new staffing structure.
The contract provides up to three hours per week of psychiatric services and up to eight hours per week from a licensed mental health counselor.
Those services are separate from the nursing hours included in the staffing schedule.
The inclusion of mental health services is particularly notable because the Sheriff’s Office was asked in the FOIA request whether there would be changes to mental health care as part of the transition to the new provider. The contract establishes dedicated psychiatric and counseling hours, although the records provided do not contain a comparison showing how those hours differ from the previous provider’s staffing.
Medication management becomes TK Health responsibility
TK Health is responsible for managing prescribed medications and ensuring they are available within a reasonable period after being ordered, except when a medication is not readily available locally.
The provider must also maintain a system documenting the administration of medications and confirming that inmates are receiving and ingesting prescribed medications.
The county, however, remains responsible for the cost of pharmaceutical services.
The agreement also permits an inmate’s home medication to be used when appropriate after the medication has been verified by TK Health personnel. TK Health is required to negotiate discounted pharmacy rates through a pharmacy licensed in Illinois.
Emergency medical transportation is also treated as an outside medical expense and paid by the county. Other nonemergency transportation connected to health care is likewise the county’s responsibility.
TK Health can review and reprice medical claims for the county at a charge of $15 per claim. The company is expected to calculate available discounts and check the integrity of the medical claim before returning it to the county for payment.
The contractor is also required to use its best efforts to negotiate discounts for medical services and pharmaceuticals.
The contract allows TK Health to help identify private health insurance coverage when available so qualifying outside medical expenses can be billed appropriately.
However, the agreement specifically states that an inmate cannot be denied appropriate medical care because of a lack of insurance or because of the inmate’s financial condition.
Insurance coverage and an inmate’s ability to pay also cannot be considered when TK Health personnel make medical decisions.
Adams County also retains responsibility for much of the physical infrastructure used by the medical operation.
Under the contract, the county provides access to office equipment, computers, office supplies, durable medical equipment, internet connectivity and telephone service required to operate the medical unit.
TK Health is responsible for standard disposable medical supplies and for costs associated with its electronic health record software.
Medical records created or obtained through the contract remain the property of the Adams County Sheriff’s Office.
TK Health serves as the custodian of those records while the contract is active. If the agreement ends, inmate medical records remain in the custody of the Sheriff’s Office.
The agreement also requires records to be maintained in accordance with applicable Illinois law and health privacy requirements.
A clearer picture of the new jail medical system
The contract provides considerably more detail about the transition than was previously publicly available.
TK Health is taking responsibility for the day-to-day coordination of inmate medical care, staffing the medical unit, conducting screenings and sick call, administering medications and arranging outside care when necessary.
At the same time, Adams County remains financially responsible for several significant categories of health care expenses that fall outside the base contract, including pharmaceuticals, hospitalization, specialty care, outside laboratory and imaging services and medical transportation.
The records also establish a defined level of mental health staffing and around-the-clock emergency consultation, while providing approximately 139 scheduled health care staff hours each week for a jail population of up to 135 inmates.
The newly released agreement offers residents a much clearer look at what Adams County is paying for inmate health services and what TK Health has agreed to provide beginning Oct. 1.
