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Scope of Work
This document sets forth the contract Scope of Work expectations between the following Divisions of the Indiana Family & Social Services Administration (FSSA): the Division of Aging (DA), the Division of Disability and Rehabilitative Services (DDRS), and the Division of Mental Health & Addiction (DMHA), and the contractor for PASRR (Preadmission Screening Resident and Review) Services.
The contract begin date will be July 1, 2018. The period of performance will be from July 1, 2018 to June 30, 21.
Responsibilities of Contractor:
a. Provision of an implementation team to develop and implement project requirements within agreed upon timeframes.
b. Collaborative work with the Department to clarify, learn, and document Departmental preferences regarding LOC interpretation and application of LOC clinical review decision rules.
c. Provision of trained, qualified clinical, administrative, leadership, and medical staff to administer and oversee the project.
d. Development of applications in conformity with state specifications.
e. Training of end users, including hospital staff, AAAs, NF staff, and state government users.
f. Should the Department establish a separate agreement with contractor to do so, a QIO physician panel will be established by Contractor to expand QIO status to the State of Indiana. This will enable the Department to claim enhanced FFP for utilization review services as permitted under Section 1903 (a)(3)(C) of the Social Security Act which specifies that 75% Federal Financial Participation is available for State expenditures for the performance of medical and utilization reviews by a QIO, or by a "QIO-like entity", which meets the requirements of section 1152 of the Act.
1. Ownership of Data: All PASRR evaluation and outcome data captured and stored in fulfillment of this contract shall be the property of FSSA.
2. Invoices: The Contractor shall submit a single monthly invoice for all work completed within each calendar month to FSSA detailing each evaluation referred and completed within each calendar month. The invoice shall be submitted by the 10th day of each month.
3. Modification of contract: No modification or change of any provision in the scope of work shall be made, or construed to have been made, unless such modification or change is mutually agreed upon in writing by Contractor, and FSSA. The agreed upon modification or change will be incorporated as a written contract amendment and processed through FSSA for approval prior to the effective date of such modification or change.
The Contractor shall not commence any additional work or change the scope of the work until authorized in writing by the State. This Contract may only be amended, supplemented or modified by a written document executed in the same manner as this Contract.
1. Expectations of Evaluations:
Level 1:
1. Web-based software must contain embedded algorithms associated with items and combinations of items that ensure that Level I screening protocols achieve the CMS mandate for Level I sensitivity to the potential presence of PASRR conditions. Even when completed by laypersons, our data elements are sensitive to the presence of PASRR conditions.
2. Web-based software must provide Level I screeners an easy-to-complete and easy-to-submit web-based Level I form, available 24/7. It must provide a fully functional end-to-end solution to Level I screening, with workflow(s) for requesting Exempted Hospital discharges, dementia exemptions, and categorical decisions. It must provide submitters easy access to print Level I outcomes as proof of PASRR completion.
3. Whenever a screen indicates no likelihood of a PASRR condition, submitters must be able to receive an immediate notification of PASRR permission to proceed with NF admission. When that occurs, screeners must be able to immediately print a copy of the authorized and completed screen, along with a notification letter explaining the outcome. For those individuals whose information suggests the potential for a PASRR disability, web-based software permits contractor or the Department to appoint a centralized team of Clinical Reviewers to review those screens for a more in-depth review and determination. Those Clinical Reviewers must be able to communicate directly with providers via Web-based software through a messaging center. In addition, providers may respond to questions, upload information, or ask questions of the Clinical Reviewer directly through the application
4. Web-based software must be able to push data to Medicaid payment authorization systems to enable states to tie NF payment to assurances that PASRR was completed prior to admission.
2. Level of Care:
1. Contractor’s LOC Pro system will provide an easy to use web-based LOC submission platform. By integrating the LOC and Level I screening submissions, LOC Pro streamlines the NF admissions screening process for providers assisting individuals to seek NF placements. The Department has chosen to use the InterRAI-HC, in combination with state specific NF LOC decision criteria as Indiana’s uniform NF LOC tool. Contractor will add InterRAI-HC items into the LOC Pro web-based screening platform. Contractor will program web-based submission of two versions of the InterRAI, the full form (for use by AAAs and NFs conducting onsite LOC evaluations) and a Departmentally selected “short form” composed of a subset of the full item set (for use by hospitals seeking NF admission for their patients at discharge). Contractor will integrate into our LOC Pro system an Indiana-specific, InterRAI-based LOC algorithms and associated LOC outcome decisions, as developed and specified by the Department. The long form algorithm will be applied to AAA and NF LOC submissions and will result in automated and printable LOC decisions. The short form algorithm developed by the Department will be applied to hospital LOC submissions and will determine which InterRAI screens will be cued to Contractor clinicians for further clinical verification and review. Hospitals will have the capacity to securely upload supporting documents as needed to facilitate LOC clinical decision making and will have the ability to print LOC outcomes. Clinically reviewed short form submissions that lead to denials for NF placement will be referred to AAAs for a follow up onsite LOC evaluation. Contractor will develop, based on a collaborative requirements gathering process with the Department, a mechanism to push LOC Pro outcomes to Indiana’s MMIS system.
2. Contractor will program web-based submission of the InterRAI short and long forms, configured with an Indiana-specific LOC algorithm and associated LOC outcome decisions as developed and specified by the Department. The broad requirements of the system build to be:
1. All items of the InterRAI (the “long form”) will be programmed and available for web-based completion and submission by AAAs and NFs.
2. Items specified by the Department will be programmed to constitute an InterRAI “Short Form” available for web-based completion and submission by hospitals. Hospitals will have the capacity to upload supporting documents as needed for LOC clinical decision making.
3. Hospital-submitted short form InterRAI screens will be cued to Contractor clinicians for clinical review. The Department will train Contractor on preferred LOC interpretation and decision rules to ensure LOC decision alignment and consistency.
4. The Department will provide Contractor the specific Indiana LOC algorithm to be applied to both the long and short forms and will specify LOC outcome decisions associated with algorithmic scoring. Contractor will integrate this algorithm within the LOC Pro system configured for Indiana.
5. Standard volume and outcome reporting is included in the cost of the build.
6. Programming of all current InterRAI required algorithms are considered to be part of this project. Programming of CAPs will not be considered part of this project.
a. Level II:
2.3 Level II
2.3.1 Vendor shall provide Diagnostic and Evaluation Services to the DDRS for the Bureau of Developmental Disabilities Services (BDDS) and to DMHA. Prior to referral Preadmission screenings (PAS) will be completed for all applicants who meet nursing facility level-of-care requirements and who have been identified as possibly having Mental Illness (MI) and/or Intellectual Disability (ID). Those individuals will then be referred to the chosen vendor to complete the Level II assessment. Additionally, the Level II assessment must be completed any time there is a change in condition as presented by BDDS or DMHA. If the individual with an intellectual or developmental disability, or a mental illness, is determined to require a Nursing Facility (NF) level of care, the contracted vendor, must also determine, in accordance with 42 CFR 483.130, whether the individual requires specialized services for the mental illness or intellectual/developmental disability, as defined in 42 CFR 483.120.
2. A Diagnostic and Evaluative assessment will be used that yields the following results:
1. DesA determination of whether, because of their mental illness or intellectual/developmental disability:
2. The individual's total needs are such that their needs can be met in an appropriate community setting;
3. The individual's total needs are such that they can be met only on an inpatient basis, which may include the option of placement in a home and community-based services waiver program, but for which the inpatient care would be required;
4. If inpatient care is appropriate and desired, the NF is an appropriate institutional setting for meeting those needs in accordance with 42 CFR 483.126; or
5. If the inpatient care is appropriate and desired but the NF is not the appropriate setting for meeting the individual's needs in accordance with 42 CFR 483.126, another setting such as an Intermediate Care Facilities for Individuals with Intellectual Disabilities.(ICF/ID) (including small, community-based facilities), is an appropriate institutional setting for meeting those needs.
6. The level of services provided by a NF or an intermediate care facility
2.3.3 Specialized services for mental illness or intellectual/developmental disability as defined in 42 CFR 483.130. Specialized services means the services specified by the State which, combined with services provided by the NF or other service providers, results in treatment which meets the requirements of 42 CFR 483.440(a)(1).
When determining if Specialized Services are required, the vendor will utilize a minimum data set as defined in 34 CFR 483.136 that includes the following:
1.Minimum data collected must include the individual's comprehensive history and physical examination results to identify the following information or, in the absence of data, must include information that permits a reviewer specifically to assess:
4. The individual's medical problems;
5. The level of impact these problems have on the individual's independent functioning;
6. All current medications used by the individual and the current response of the individual to any prescribed medications
7. Self-monitoring of health status;
8. Self-administering and scheduling of medical treatments;
9. Self-monitoring of nutritional status;
10. Self-help development such as toileting, dressing, grooming, and eating;
11. Sensorimotor development, such as ambulation, positioning, transfer skills, gross motor dexterity, visual motor perception, fine motor dexterity, eye-hand coordination, and extent to which prosthetic, orthotic, corrective or mechanical supportive devices can improve the individual's functional capacity;
12. Speech and language (communication) development, such as expressive language (verbal and nonverbal), receptive language (verbal and nonverbal), extent to which non-oral communication systems can improve the individual's function capacity, auditory functioning, and extent to which amplification devices (for example, hearing aid) or a program of amplification can improve the individual's functional capacity;
13. Social development, such as interpersonal skills, recreation-leisure skills, and relationships with others;
14. Academic/educational development, including functional learning skills;
15. Independent living development such as meal preparation, budgeting and personal finances, survival skills, mobility skills (orientation to the neighborhood, town, city), laundry, housekeeping, shopping, bed making, care of clothing. Independent development is expected to include orientation skills for individuals with visual impairments.
16. Vocational development, including present vocational skills;
17. Affective development such as interests, and skills involved with expressing emotions, making judgments, and making independent decisions; and
18. The presence of identifiable maladaptive or inappropriate behaviors of the individual based on systematic observation (including, but not limited to, the frequency and intensity of identified maladaptive or inappropriate behaviors).
1. Based on the data compiled the vendor must validate that the individual has a mental illness or an intellectual/developmental disability or is a person with a related condition and must determine whether specialized services for intellectual disability are needed. In making this determination, the vendor must make a qualitative judgment on the extent to which the person's status reflects, singly and collectively, the characteristics commonly associated with the need for specialized services, including:
1. Take care of the most personal care needs;
2. Understand simple commands;
3. Communicate basic needs and wants;
4. Be employed at a productive wage level without systematic long term supervision or support;
5. Learn new skills without aggressive and consistent training;
6. Apply skills learned in a training situation to other environments or settings without aggressive and consistent training;
7. Demonstrate behavior appropriate to the time, situation or place without direct supervision; and
8. Make decisions requiring informed consent without extreme difficulty;
9. Demonstration of severe maladaptive behavior(s) that place the person or others in jeopardy to health and safety; and
10. Presence of other skill deficits or specialized training needs that necessitate the availability of trained ID/DD personnel, 24 hours per day, to teach the person functional skills.
2. The evaluation conducted by the vendor must involve, at a minimum:
1. The individual being evaluated;
2. The individual's legal representative, if one has been designated under State law; and
3. The individual's family if available and the individual or the legal representative agrees to family participation
3. The evaluation conducted by the vendor must be adapted to culture, language, and ethnic origin and conducted in the means of communication used by the individual being evaluated.
A. The evaluation report, for individualized PASARR Level II determinations, findings must be issued in the form of a written evaluative report which includes the following:
1. Identifies the name and professional title of person(s) who performed the evaluation(s) and the date on which each portion of the evaluation was administered;
2. Provides a summary of the medical and social history, including the positive traits or developmental strengths and weaknesses or developmental needs of the evaluated individual;
3. If NF services are recommended, identifies the specific services which are required to meet the evaluated individual's needs, including specialized services
4. If specialized services are not recommended, identifies any specific services for individuals with a mental illness or intellectual/developmental disabilities which are of a lesser intensity than specialized services that are required to meet the evaluated individual's needs;
5. If specialized services are recommended, identifies the specific services required to meet the evaluated individual's needs and outlines a recommended frequency and duration of those specialized services and;
6. Includes the bases for the report's conclusions.
3. Qualifications:
1. The Centers for Medicare and Medicaid Services have identified that Level II evaluator qualifications include enough training to comprehend psychiatric reports. Such training can be found among psychiatrists, clinical psychologists, clinical social workers, and some nurses.
2. FSSA asks that the selected vendor have a personal commitment to person centered planning and maximum community integration for individuals with a mental illness (MI) and/or intellectual disabilities (ID).
4. Tier One Support:
1. Answering email and phone questions from providers or system users
2. Escalating system issues to IT for resolution
3. Providing general reporting of volume
4. Assisting with timely mailing of determination notifications, performing standard Contractor quality review on the letters (matching individual name on each page of the letter)
5. Tier Two Support:
1. Provide technical knowledge beyond that of Tier One
2. Staffed by technicians who have troubleshooting capabilities beyond Tier One
3. Technicians will have specialized skills and will determine which specialization best matches the customer’s needs before helping is provided.
4. If their technical specialization is one that can help the customer, the tech in consultation with FSSA will then determine whether this problem is a new issue or an existing one.
5. Advanced diagnostic tools and data analysis may be done at this point. If the issue is an existing one, the Tier-II specialist then finds out if there is a solution or a workaround in the database. The customer is then told how to correct the issue.
6. Tier Three Support:
1. Provide technical knowledge beyond that of Tier One or Tier Two
2. Staffed by developers at the company responsible for the product
3. Staffed by people who have specialized skills over and above the Tier One and Tier Two Support.
7. Communication and Education:
1. Produce and host live webinars to providers for ongoing education in the Indiana PASRR process and how to properly use the Contractor’s system. Review with FSSA prior to launch.
2. Produce and distribute newsletters to providers for ongoing education in the Indiana PASRR process and how to properly use the Contractor’s system. Review with FSSA prior to launch.
3. Maintain communication with the State through regular conference calls to address any issues and modify the service as needed.
8. Turnaround Times (due dates):
1. Level 1: A minimum of 6 business hours from the time of submission in the Contractor’s system. The Contractor must maintain an average turnaround time of 6 hours or less. The Contractor must report to the DA whenever the average turnaround time exceeds this benchmark.
2. Level 2: A minimum of 5 business days from the day of referral from the State’s PASRR Level I entity. The Contractor must maintain an average turnaround time of 5 business days or less. The Contractor must report to the DMHA and DDRS whenever the average turnaround time exceeds this benchmark. Calculation of turnaround times shall be as follows: The day after receipt of referral shall be considered “Day 1”, the second Day after the day of referral shall be considered “Day 2” and so forth.
3. LOC: A minimum of 6 business hours from the time of submission in the Contractor’s system. The Contractor must maintain an average turnaround time of 6 hours or less. The Contractor must report to the DA whenever the average turnaround time exceeds this benchmark.
4. Tiered Support: Respond within 24 business hours of submission to all types of Tiered Support. The Contractor must maintain an average turnaround time of 24 business hours or less. The Contractor must report to the FSSA whenever the average turnaround time exceeds this benchmark.
9. Communication & Education:
1. Webinars: Will be developed and hosted quarterly
2. Newsletters: Will be developed and distributed quarterly
3. Conference Calls: At least monthly, with option for more frequent communication when necessary
10. Volume:
1. Level 1: The minimum annual volume of Level I PASRR assessments is estimated by DA as 9,500
2. Level of Care: The minimum annual volume of Level of Care assessments is estimated by DA as 3,500.
1. Level II:
1. DDRS: The minimum annual volume of IDD Level II PASRR evaluations is estimated by DDRS as 1200, and is inclusive of Preadmission and status change PASRR evaluations.
2. DMHA: The minimum average, annual volume of MH Level II evaluations is estimated by DMHA as 6,000.
2. Tier One Support:
1. Emails: The minimum annual volume of emails is projected to be 11,000
2. Phone Calls: The minimum annual volume of phone calls is projected to be 8,000.
11. Interpreter Services:
1. When/if the individual does not speak English or is deaf/hearing impaired, Contractor will arrange for an interpreter to a contractor the Independent Contractor/Assessor during the assessment with the individual and follow-up calls with family members or guardians, if indicated. Interpreter fees will be billed to the Agency at the rates reflected in the contract fee schedule.
12. Hearing & Appeals:
13. Contractor will assist with the preparation of any DA, DDRS, DMHA Hearing & Appeal packets, and at the Agency’s request, will participate in hearings via telephone. For Hearing & Appeal related document management, doctor review, and hearing preparation and participation, Contractor will be paid at the hourly rate reflected in the contract fee schedule.
14. Reports:
1. The Contractor shall be responsible for reporting to facilitate the State of Indiana’s comprehensive PASRR process, including qualitative improvement and quality assurance processes. The Contractor’s obligations in this regard include, but are not necessarily limited to, the following. The Contractor shall:
2. Provide on-demand reports as requested by FSSA.
Provide the following reports:
|Title |Due Date |Report Description |
|Annual Activity Report |Due by the 15th calendar day of the |This narrative report includes annual information |
| |month following the end of the year.|including the status of PASRR Level I screenings |
| | |and Level II evaluations completed and average |
| | |annual turnaround times. This report does not |
| | |include any client level data so that it can be |
| | |shared publicly. |
|Level I and Level II Detail Monthly & YTD Report |Due by the 15th calendar day of the |This will include monthly details on all |
| |month following the month being |individuals with Level I and Level II outcomes. |
| |reported. |Report total Level 1 reviews, number & percent of |
| | |automatic (algorithm) approvals, number & percent |
| | |receiving clinician review. Report percent of |
| | |those reviewed where no Level II required. |
| | | |
| | |This data will include all quality metrics |
| | |currently measured in the PASRR Technical Center |
| | |report (see attached) |
|Level of Care Detail Monthly & YTD Report |Due by the 15th calendar day of the |This will include monthly details on all |
| |month following the month being |individuals with Level of Care assessments. Report|
| |reported. |total assessments, number & percent of automatic |
| | |(algorithm) approvals, number & percent receiving |
| | |clinician review, number and percent of long form |
| | |and short form reviews. Report percent of those |
| | |reviewed where a referral was made for onsite |
| | |validation of a denial and the percentage of those|
| | |that were in fact denied (also note that as a |
| | |percentage of total assessments). |
|Level I QA Monthly & YTD Detail Report |Due by the 15th calendar day of the |Report on the 2% of Level I screens monitored in |
| |month following the month being |the month and outcome information. Report number |
| |reported. |reviewed and quality issues by type and any |
| | |actions taken with providers, e.g. webinars, |
| | |one-on-one technical assistance. |
|Level of Care QA Monthly & YTD Detail Report |Due by the 15th calendar day of the |Report on the 2% of Level of Care assessments |
| |month following the month being |monitored in the month and outcome information. |
| |reported. |Report number reviewed and quality issues by type |
| | |and any actions taken with providers, e.g. |
| | |webinars, one on one technical assistance. |
|Exempted Hospital Discharges, Monthly & YTD |Due by the 15th calendar day of the|Report on total number of EHDs by facility, on |
|adjusted for lag |month following the month being |number and length of non-compliant cases by |
| |reported |facility by volume during period analyzed; number |
| | |by facility and total of EHDs longer than 45 days |
| | | |
| | |This data will include all EHD quality metrics |
| | |currently measured in the PASRR Technical Center |
| | |document (see attached) |
|Monthly Activity Report |Due by the 15th calendar day of the |This narrative report describes all monthly |
| |month following the month being |activities including the number of PASRR Level I |
| |reported. |screenings completed, number of Categorical |
| | |Determinations completed, number of Level II |
| | |evaluations completed, average monthly turnaround|
| | |times, system outages, calculation of monthly |
| | |system availability and a list of all positions |
| | |hired or subcontracted during the month. This |
| | |report does not include any client level data so |
| | |that it can be shared publicly. |
|Quarterly Quality and Activity Report |Quarterly for periods ending |This narrative report addresses all quality |
| |September, December, March, and |related activities for each quarter, provider |
| |June. Due by the 15th calendar day |training and communication, Appeals, |
| |of the month following the end of |Reconsiderations and quality complaints |
| |the quarter. |information. It also describes the status of PASRR|
| | |Level I screenings and Level II evaluations |
| | |completed and average quarterly turnaround times. |
| | |This report does not include any client level data|
| | |so that it can be shared publicly. |
|Specialized Services Review Detail Report |Quarterly for periods ending |This report will include details on all individual|
| |September, December, March, and |reviews of NF care plans and delivery of SS, RS, |
| |June. Due by the 15th calendar day |and CPS, compliance issues, and outcomes. It will |
| |of the month following the end of |also include the number of reviews started, |
| |the quarter. |cancelled, in-progress and completed and any other|
| | |identified elements requested by the Agency. |
|Specialized Services Review Report |Due by the 15th calendar day of the |This report will include aggregate data elements |
| |month following the month being |related to the review of NF care plans and |
| |reported. |delivery of SS, RS, and CPS, compliance issues, |
| | |and outcomes. |
|Data file with LOC information for the MMIS |Daily file submission to location |Includes new LOC, continued stay request |
| |identified by MMIS provider |approvals, NF transfers |
|Complete data file for data warehouse |Weekly file submission to location |All data, Level I, Level II, admissions, |
| |identified by FSSA |discharges, LOCs, and all interRAI data. |
15. Technology:
1. It is expected that the Contractor will utilize a workflow tracking system sufficient to support the efficient operational needs of this contract and to provide reports to FSSA regarding timeliness, outcomes, and types of referrals received. It is acknowledged that any technology utilized for these purposes is the property of the Contractor.
2. Contractor will meet all requirements for Indiana Office of Technology Security Protocols (see attached).
3. IT Disaster Recovery
A. Contractor will ensure protection from data loss or destruction through or rigorous IT security and redundancy measures. All operations data will be maintained in a secure platform, which will provide automated, geographically-dispersed disaster recovery within the United States.
B. Contractor’s primary data and servers will be hosted in a secure datacenter and will be replicated throughout the day within the primary datacenter and to a secondary datacenter in the U.S. If a primary data or server failure occurs Contractor will be able to recover in the primary or secondary datacenter depending on which datacenter can provide the required data and server services.
16. Information Security
1. Contractor will execute a HIPAA Business Associate Agreement (BAA) with Microsoft to ensure HIPAA privacy and security rule compliance.
2. Contractor must understand the importance of ensuring the security of protected health information (PHI), and will deploy multiple strategies to ensure that PHI stays protected. System must be designed to permit such access via a Secure Socket Layer (SSL) website with 256-bit encryption — a process that will ensure data security. Log-on capability to the web portal will be controlled through a strictly monitored log-on access credentialing process. Users must identify themselves to the system via distinct log-on names and passwords. Because of the security measures in place, information transmitted through Contractor’s secure web portal will remain secure whether the user is connected directly through an Ethernet connection, supported web browser (e.g., Microsoft Internet Explorer) or wirelessly from any location.
3. Contractor will require Hypertext Transfer Protocol Secure (HTTPS) with 256-bit encryption for Data in Motion and web-based user authentication (i.e., username and password). User registration and authorization will be managed by Contractor and require contact and affiliation verification for approval.
17. Partitioning in Multitenant System
1. System will be designed so that Indiana will be a “tenant” alongwith other states in the multi-tenant system. Row-level tenant data partitioning will be implemented in the multitenant database, and application user roles will be implemented to further secure tenant data and functionality (e.g. report) access. This row-level lockdown means that no other tenants (i.e., other states’ users) can access Indiana’s data. Other tenants can’t “jump” to another row to gain access to Indiana’s data. The row is tagged as Indiana data, and only users with approved Indiana access can see the data. Conversely, any approved Indiana user cannot jump a row to access another tenant’s data. That other row is tagged for another state, along with all the data belonging to the state.
2. Contractor will further protects data by showing the minimum data required. When an approved user accesses an Indiana data row, they see only the data their user role allows. For example, a hospital submitter may access records submitted by the hospital, but may not access records submitted by another hospital. A state officer may need to access records submitted by all hospitals in the state, but again, that is governed by that officer’s Departmentally-approved user role.
3. This row level partitioning will allow for scalability to keep the application costs lower for state customers. This also creates more efficient reporting and operations for Contractor and therefore for the Department; and more efficient updating of national level forms and protocols to ensure all tenants receive the same best-practice updates simultaneously.
4. The combination of closely managed and verified user registration to grant user roles and row level partitioning based on each user’s verified credentials is what ensures that: 1) only Indiana users can access Indiana data; and, 2) each individual Indiana user can access only data for which that user has verified permission/ authorization to view.
18. Development, Compliance, and Diagnostic Tools
1. Network, application, and data event logs will be used to audit data accessed and updated by users. The application will be implemented, secured, and audited.
19. Physical Security
1. In addition to these technology solutions, Contractor further ensures data security and PHI protection by carefully guarding access to our offices. Upon joining Contractor, employees will be issued secure access cards that allow entry into our suite. No one can gain entry without such a card, which is collected and re-secured when an employee no longer works for the company. Visitor access is restricted via a call button which signals a designated Contractor employee to greet the individual and verify that they are authorized to enter the suite. All visitors must sign in and be escorted at all times during their visit.
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