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HomeMy WebLinkAbout2014-460 Health - Piedmont Health Services for PHS and OCHD agree for certification of WIC clients at OCHD $0 PHS/OCHD Memo of Agreement FY 14-15 Memorandum of Agreement Between Piedmont Health Services,Inc. WIC Program and Orange County Health Department For WIC Program Services This Memorandum of Agreement made and entered into the 1St day of July 2014 by and between the Orange County Health Department ("OCHD") and Piedmont Health Services WIC Program ("PHS"). WITNESSETH: WHEREAS, both PHS and OCHD deem it to be of mutual interest to their atients/clients and their respective organizations to enter into this agreement for certification of WIC clients at OCHD; and WHEREAS, both parties desire to reduce the terms of this agreement to writing; NOW THEREFORE, and in consideration of the mutual promises to the other as hereinafter set forth,the parties hereby mutually agree as follows: A. PHS agrees to perform in a manner satisfactory to OCHD the following responsibilities: 1. Provide WIC services to Maternal and Child Health clinic clients at OCHD in Hillsborough following the policies, procedures and flow of patients as established by OCHD. Services will include height and weight assessment, nutrition assessment and education, WIC certification, food vouchers issuance, child immunization assessment, and appropriate patient referrals in accordance with state WIC policies. 2. Provide the necessary supervision, training and policy guidance to carry out the tasks identified above in consultation with the designated OCHD liaison. 3. Provide personnel for coverage during vacations and other approved leave except PHS scheduled holidays and unavoidable emergencies. Inform the OCHD liaison when WIC staff will be absent so that OCHD clinic staff can be notified. 4. Schedule meetings as needed with the OCHD liaison and WIC Director to discuss problems,procedures, changes in policy and to establish and review objectives. 5. Reimburse OCHD, on a quarterly basis, Ten dollars ($10)per client for each client that is not an OCHD patient, for testing of hemoglobin on WIC clients. 6. Piedmont Health Services will provide their own interpreter services for clients receiving WIC services, including laboratory services at the OCHD location in accordance with Title VI and Title 11 requirements. 1 PHS/OCHD Memo of Agreement FY 14-15 B. OCHD agrees to perform in a manner satisfactory to PHS the following responsibilities: 1. Provide reasonable working space and equipment necessary for carrying out WIC responsibilities in the Hillsborough office. 2. Provide access to Medical Records for the purpose of gathering medical information and for project evaluation. 3. Through its liaison, OCHD shall be responsible for the following: a. Meet, as needed, with the PHS WIC Director to discuss problems, procedures, changes in policy and to establish and review objectives. b. Inform WIC staff of OCHD holidays, closings, clinic changes, and staff absences, which may affect the delivery of WIC services. 4. Perform hemoglobin testing for all WIC clients served at the Hillsborough OCHD site and submit invoices on a quarterly basis to Piedmont Health Services, Inc. for non-OCHD clients. C. Term. This agreement is for the performance of services rendered during the period beginning July 1, 2014 and ending June 30, 2015. D. Termination. Either party may terminate this agreement by giving 90 days written notice to the other party. E. Non-Appropriation. It is understood and agreed between PHS and OCHD that continuation or any renewal or extension thereof, is dependent upon and subject to the allocation or appropriation of funds to PHS and/or to OCHD for the purposes set forth in this agreement. It is also understood and agreed that either party shall involve the other in significant scheduling or program changes, which may affect services. F. Access to Records. OCHD agrees that the State of North Carolina, United States Department of Agriculture, the Controller General of the United States, or any of their duly authorized representatives, shall have access to any books, documents, papers and records of OCHD which are directly pertinent to this specific agreement, for the purposes of audit, making excerpts and transcriptions. G. Compliance with Laws. All parties agree to abide by all laws and regulations governing the confidentiality of patient information, including HIPAA privacy rules and further agree to vigorously safeguard privileged information. H. Non-discrimination. All activities under this agreement shall be conducted in accordance with Title VI, Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, WIC Program Rules, regulations and policies, the Americans with Disabilities Act and all other applicable State and Federal laws regarding employment. Standards for being 2 PHS/OCHD Memo of Agreement FY 14-15 served by the WIC Program are the same for all people no matter what race, color, national origin, age, handicap or sex. I. Renewal of Agreement. This agreement may be renewed upon the mutual agreement of both parties. Any renewal shall be negotiated 30 days prior to the beginning date of the new contract period. J. Amendment. This agreement may be amended upon the mutual agreement of the parties. All amendments shall be in writing and signed by both parties to the agreement. k. Notices. Any notice required by this Agreement shall be in writing and delivered by certified or registered mail, return receipt requested to the following: Orange County Health Department PHS Name Attention: Accounts Payable Attention: Brian Toomey 300 West Tryon Street 299 Lloyd Street Hillsborough,NC 27278 Carrboro Nc, 27510 1. Signatures. This Agreement together with any amendments or modifications may be executed electronically. All electronic signatures affixed hereto evidence the intent of the Parties to comply with Article 11A and Article 40 of North Carolina General Statute Chapter 66. IN WITNESS WHEREOF, the Parties, by and through their authorized agents, have hereunder set their hands and seal, all as of the day and year first above written. Brian Toomey, Executive irector Date Piedmont Health Services, Inc. Colleen Bridger, Health Direo6r Date Orange County Health Department App ved as f rm and legal sufficiency talts� l4- Annette M. Moo e, Staff Attorney Date This instrument has been pre-audited in the manner required by the Local Government Budget an ca ontrol Act Clarence G. Grier,Assistant Co. Manager& CFO 3 PIEDM17 OP ID: KB CERTIFICATE OF LIABILITY INSURANCE DA1 0/1 412 0 1 4Y) 10/14/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Senn Dunn-High Point NAME: Dick Dickens,CIC 1400 Point,Eastchester 2 7265 PHONE FAX High Point, Drive,St 200 A/C No Ext:336-899-2406 A/c No): IiESS:ddickens@senndunn.com M.Bryan Beasley,CIC ADO INSURER(S)AFFORDING COVERAGE NAIC p INSURER A:Selective Insurance CO of Amer 12572 INSURED Piedmont Health Services Inc. INSURER B:Selective Insurance Companies 12572 299 Lloyd St. Carrboro, NC 27510 INSURER C: INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR L SUBIR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE iNqR vrvn POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 19000,00 B X COMMERCIAL GENERAL LIABILITY S1971482 02/01/2014 02/01/2015 PREMISES RENTED occurrence $ 100,00 CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 5,00 B X BusinessOwners S1971481 02/01/2014 02/01/2015 PERSONAL$ADVINJURY $ 1,000,00 GENERAL AGGREGATE $ 3,000,00 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 3,000,00 POLICY PRO- LOC $ AUTOMOBILE LIABILITY Oa accident)t ED SINGLE LIMIT E $ 1,000,00 B X ANY AUTO 51971482 02/01/2014 02/01/2015 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS PER ACCIDENT $ �( UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,00 B EXCESS LIAB CLAIMS-MADE S1971482 02/01/2014 02/01/2015 AGGREGATE $ 3,000,00 DED X RETENTION$ -0- $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN RY LIMIT ER A ANY PROPRIETOR/PARTNER/EXECUTIVE WC 7977892 02/0112014 02/01/2015 E L EACH ACCIDENT $ 500,00 OFFICER/MEMBER EXCLUDED? ❑ NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,00 If yes,describe under D ESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION ORANGOV SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Orange County Government ACCORDANCE WITH THE POLICY PROVISIONS. 200 S Cameron Street Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE V a ©1988-2010 ACORD CORPORATION. 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