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HomeMy WebLinkAbout2004 S Health - Renewal Chapel Hill Training & Outreach, Inc & Health Dept for Dental -Head Start~~ ~1~~/may AGREEMENT BETWEEN The Orange County Health Department As a part of the County of Orange AND Chapel Hill Training/Outreach Project, Inc.: Orange County Head Start and Early Head Start THIS AGREEMENT, made and entered into this 1st day of July, 2004 by and between The Orange County Health Department hereinafter referred to as "OCHD" for its Dental Health Services Division; and the Orange County Head Start/Early Head Start Program of the Chapel Hill Training/Outreach Project, Inc., hereinafter referred to as " OCHS/EHS". WITNESSETH WHEREAS, OCHS/EHS desires the services of a dentist(s) licensed by the State of North Carolina with experience or training in children's dentistry, and WHEREAS, the Health Coordinator of OCHS/EHS and the Director of Dental Health Services, OCHD shall administer this program and, WHEREAS, OCHD desires to contract with OCHS/EHS to provide a dentist(s) licensed by the State of North Carolina to provide services and to serve as a consultant to OCHS/EHS; NOW THEREFORE, in consideration of the premises and of the following mutual promises, covenants and conditions, OCHD and OCHS/EHS agree as follows: 1. OCHD shall provide a dentist(s) licensed to practice in the State of North Carolina to be available to OCHS/EHS to serve as a consultant, and to provide dental services to the children enrolled at OCHS/EHS and determine priority of dental needs for the program/children. Initial screening will be done for all children enrolled as of June 1, 2004, 3-5 years of age, to be screened at the OCHS/EHS Head Start centers. In addition, a full examination is required within 90 days of enrollment; that examination will be conducted at the OCHD Hillsborough dental services site. Enrollees after this date are to be transported by OCHS/EHS to the clinic for examination on the same day with children who have appointments. 2. As a result of the initial screening, OCHD will assign children to groups according to the following: A) Those with immediate need B) Those with apparent need C) Those with no apparent need 04-05 Head Start Dental 1Contract.doc 3. OCHD will provide treatment services to each group as follows: A) Examination B) Needed extractions C) Needed restoration including pulp therapy and stainless steel crowns, if needed D) Prophylaxis and topical fluoride application where indicated 4. OCHD will provide educational services which may include but not be limited to the following: A) Dental health education for children B) Dental health education for parents C) Dental health education for staff D) Suggestions for classroom activities E) Hand-outs to be taken home by the children 5. OCHD will complete the CAP-H.S.S.-30 forms pertaining to dental health and return the forms to OCHS/EHS to be made a part of the child's permanent Head Start record. 6. OCHD will file for M edicaid/other t hird p arty i nsurance p tans f or r eimbursement w hen n ecessary (OCHS/EHS is not a health provider, therefore cannot file). 7. OCHD will submit a bill to Angela Wilcox, Director, OCHS/EHS, in the amount of $10,000 on an annual basis. OCHS/EHS agrees to pay the OCHD in two installments, $5,000 by December 31, 2004 and the remaining $5,000 by June 30, 2005, upon receipt of OCHD original invoice. The check should be made payable to Orange County Health Department and mailed to Letitia Burns, Central Administrative Services Director, PO Box 8181, Hillsborough, NC. 8. OCHS/EHS agrees as follows: a. To transport no more than 5-10 children to be scheduled at least every other week on a block basis and to provide adequate supervision in the waiting room. OCHS/EHS shall be responsible for obtaining and maintaining adequate automobile liability insurance as required by law and if requested will furnish to the County certificates of such insurance. b. To arrive for the scheduled appointments on-time with all children scheduled for that day. OCHS/EHS shall be responsible for re-scheduling any appointments unable to be met at least 24 hours in advance. b. To provide necessary parental permissions, information for the Eligibility Determination forms, and the Medical and Dental Histories for each child prior to that child undergoing treatment. OCHS/EHS will bring all signed forms on the day of service. c. To provide CAP-H.S.S.-30 forms pertaining to dental health and will make the completed form a part of the child's permanent OCHS/EHS record. d. To obtain a copy of each child's Medicaid card or other dental insurance and bring a copy to the OCHD on the scheduled day of service. 9. In the event that enrollment in OCHS/EHS program ceases or is significantly reduced during the term of this agreement, OCHS/EHS may terminate this agreement upon 30 days notice and OCHD will return a pro rata share of the payment for services not provided (approximately $100 per enrolled child for those children whose dental work has not been started). 10. The parties agree that there shall be no unlawful discrimination based upon race, color, ancestry, religion, sex, age, disability or veteran status. 11. The parties agree to abide by HIPAA regulations in the sharing of protected health information. 12. The term of this initial Agreement is for a period of one year commencing on the 1st day of July, 2004 and terminating on the 30th day of June, 2005. This agreement shall be renewable by written agreement signed by the official representatives of the parties. Either party may terminate this Agreement after providing thirty (30) days notice. 13. The parties agree to the full and complete performance of the mutual covenants contained herein and that this Agreement constitutes the sole, full and complete agreement by and between the parties; and no amendments, changes, additions, deletions or modifications to or of this Agreement shall be valid unless reduced to writing, signed by the parties and attached hereto. 14. This agreement shall be governed by the laws of the State of North Carolina. FOR AND ON BEHALF OF: Orange County Head Start/Early Head Start .~_ Angela W it x, Director ~ ~~ ~° Date FOR AND ON BEHALF OF THE COUNTY OF ORANGE / 7 ~ ~~ Rosemary L. mmers, Health Director Date Orange Cou Health Department ~. /~d~ acobs, C it Date Orange Coy~-t r B and o Com 'ssioners ORANGE CO CE DIRECTOR: "This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control ~ Ken Chavious Date Finance Director