Commissioners approve NAF Care inmate medical contract; ADP threshold, off-site costs discussed
September 01, 2026 | Pueblo County, Colorado
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Pueblo County commissioners voted to approve an inmate medical services agreement with NAF Care on Sept. 1 after lengthy discussion about how the contract handles average-daily-population (ADP) thresholds and off-site medical costs.
A county representative explained the contract is written as a monthly flat fee and that NAF Care was selected through a competitive RFP process. The presenter said the original threshold in negotiations had been 640 ADP and was negotiated down to 500. He outlined three categories that could push costs above the flat fee: reimbursable off-site care that the county would pay when NAF Care facilitates hospital billing, a per-diem charge (about $5.95 per inmate per day) if the 30-day ADP exceeds 500, and certain pharmaceutical costs that could increase total spending.
Commissioners questioned whether a baseline of 450 or 475 ADP would be more appropriate given recent operational counts near the mid-400s; agency staff responded that 500 was selected to reduce the chance of triggering per-diem charges and that the county can renegotiate if averages approach the threshold. Staff clarified ADP is calculated weekly and averaged monthly; per-diem determinations use a 30-day window.
On budgeting, staff said the last contract figure was about $5.6 million and that the county had budgeted roughly $6.2 million to cover medical contracts and off-site care; commissioners requested that staff compile historical off-site medical cost data to inform 2027 budget planning. The board approved the contract by voice vote and directed staff to provide the requested cost breakdowns.
A county representative explained the contract is written as a monthly flat fee and that NAF Care was selected through a competitive RFP process. The presenter said the original threshold in negotiations had been 640 ADP and was negotiated down to 500. He outlined three categories that could push costs above the flat fee: reimbursable off-site care that the county would pay when NAF Care facilitates hospital billing, a per-diem charge (about $5.95 per inmate per day) if the 30-day ADP exceeds 500, and certain pharmaceutical costs that could increase total spending.
Commissioners questioned whether a baseline of 450 or 475 ADP would be more appropriate given recent operational counts near the mid-400s; agency staff responded that 500 was selected to reduce the chance of triggering per-diem charges and that the county can renegotiate if averages approach the threshold. Staff clarified ADP is calculated weekly and averaged monthly; per-diem determinations use a 30-day window.
On budgeting, staff said the last contract figure was about $5.6 million and that the county had budgeted roughly $6.2 million to cover medical contracts and off-site care; commissioners requested that staff compile historical off-site medical cost data to inform 2027 budget planning. The board approved the contract by voice vote and directed staff to provide the requested cost breakdowns.
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