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Home My WebLink About2011-330 Health - Chapel Hill Training and Outreach, Inc. for dental services for Head Start, Early Head Start program Agreement with OCEHS for Dental Services FY 2011-2012 AGREEMENT BETWEEN �LJ C�O p� ORANGE COUNTY HEALTH DEPARTMENT AND CHAPEL HILL TRAINING AND OUTREACH, INC., FOR DENTAL SERVICES FOR ORANGE COUNTY HEAD START AND EARLY HEAD START THIS AGREEMENT, effective from July 1, 2011 through June 30, 201, made 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 and Outreach 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 August 1, 2011, 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 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 D) Prophylaxis and topical fluoride application where indicated E) Provide follow-up documentation of dental exams and treatment on each child F) Referral of children with severe need to UNC School of Dentistry for evaluation and possible acceptance for treatment Page 1 of 4 S:\Managers Working Files\Contracts\Dental\FY 11-12 Head Start Dental Contract.doc I Agreement with OCEHS for Dental Services FY 2011-2012 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, including meeting with a dental staff member and individual parents of children requiring follow-up treatment 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 Medicaid/other third party insurance plans for reimbursement when necessary(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$4,000 on an annual basis. OCHS/EHS agrees to pay the OCHD in two installments, $2,000 by December 31, 2011 and the remaining $2,000 by June 30, 2012, upon receipt of OCHD original invoice. The dental services will include initial screenings to five OCHS classrooms to a total of 80 children and dental exams and follow-up services needed for 20-25 Head Start children who do not have a dental home and are eligible for Medicaid. The check should be made payable to Orange County Health Department and mailed to Erin Langston, Financial &Administrative Operation Director, PO Box 8181, Hillsborough, NC. 8. OCHS/EHS agrees as follows: a. To transport no more than 5-10 children at a time to be scheduled in a block of time 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. C. 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. d. 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. e. 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, national origin, religion, sex, age, disability or veteran status. Page 2 of 4 S:\Managers Working Files\Contracts\Dental\FY 11-12 Head Start Dental Contract.cloc Agreement with OCEHS for Dental Services FY 2011-2012 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, 2011 and terminating on the 30th day of June, 2012. 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. Page 3 of 4 S:\Managers Working Files\Contracts\Dental\FY 11-12 Head Start Dental Contract.doc Orange County Head Start/Early Head Start Chapel Hill Training-outreach Project,Inc. 800 Eastowne Drive,Suite 105 ® Chapel Hill,North Carolina 27514 Telephone:(919)490-5577 Ext:242 Fax:(919)490-4905 www.chtop.com October 11, 2011 Anne Hill,Administrative Officer Orange County Health Department 300 West Tryon Street Hillsborough, NC 27278 Re: 2011-12 Agreement for Dental Services for Orange County Head Start near NAs, Nil!, Thank you for providing a proposed contract for 201-12. After meeting with dental clinic personnel to discuss the clinic's availability and based upon the previous two years of services needed for Head Start children without a dental home, we are proposing the following revisions to the agreement: On page 2 of 4, Section Number 7 7. The OCHD will submit a bill for dental services to Angela Wilcox, Director, OCHS/EHS, in the amount of 4000 on an annual basis. OCHS/EHS agrees to pay the OCHD in two installments,$2,000 by December 31, 2011, and the remaining 2000 by June 30, 2012, upon receipt of OCHD original invoice. The dental services will include initial screenings to five OCHS classrooms to a total of 80 children and dental exams and follow-up services needed for 20-25 Head Start children who do not have a dental home and are eligible for Medicaid billing. We based our estimate of 20-25 on the previous two years of contracting with the OCHD. We are seeing that many more of our Head Start children do have a dental home upon enrollment,which is a good thing and means that both of our programs are probably making a positive difference! So,we based the payment amounts on the following estimates: 20-25 dental clinic visits at$100/visit= $2500 15 hours of classroom screenings and education at$100/hour= 1500 TOTAL=$4000 Please advise m: as to the next srEp• We have ucell +ii i.0iirdc.t wllil tlii dental Clfillc and are WUr" Ing with them on scheduling clinic visits. Due to staff shortages,they were not able to consider starting clinic services to our children until the end of October. I can be reached at 490-5577 Ext. 247 to discuss the next steps. Or you may email me at awilcox@chtop.org Thank you for working with us to better serve Orange County families. Sincerely, Angel Wilcox, Director Orange County Head Start/Early Head Start Orange County Head Start/Early Head Start Chapel Hill Training-Outreach Project,Inc. ® 800 Eastowne Drive,Suite 105 Chapel Hill,North Carolina 27514 Telephone:(919)490-5577 Eat:242 Fax:(919)490-4905 www.chtop.com October 13, 2011 Anne Hill,Administrative Officer Orange County Health Department 300 West Tryon Street Hillsborough,NC 27278 Re: 2011-12 Agreement for Dental Services for Orange County Head Start Dear Ms. Hill, Enclosed are three (3) copies of the proposed contract which I have signed and am forwarding to you for processing with the Orange County Health Department. I can be reached at 490-5577 Ext. 247 or by email at awilcox@chtop.org. Thank you for your help in expediting the process and we look forward to working with the dental clinic again this school year. Sincerely, .Angela ilcox, Director Orange County Head Start/Early Head Start Agreement with OCEHS for Dental Services FY 2011-2012 FOR AND ON BEHALF OF ORANGE COUNTY HEAD START/EARLY HEAD START Angela Wilc ' , Director Date FOR AND ON BEHALF OF THE HEALTH DEPARTMENT Dorothy Cilenti, Inted Health Director Date Orange County Health Department FOR AND ON BEHALF OF THE COUNTY OF ORANGE "VA Frank C%on, Cou anager Date Approv s to form and legal sufficiency 4- ___� It � 1 ( Annette . Moore, Staff Attorney D to ORANGE COUNTY FINANCE DIRECTOR: "This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act." I I-d1t.-U., 'P, /�_ Niql ') Clarence Grier Date Finance Director Page 4 of 4 S:\Managers Working Files\Contracts\Dental\FY 11-12 Head Start Dental Contract.doc