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Home My WebLink About2015-634-E Health - NC Public Health Foundation for Quit Line Amendment DocuSign Envelope ID:4C485144-3EA1-4A86-8777-0808354A83DE ORANGE COUNTY AMENDMENT TO SERVICES AGREEMENT NORTH CAROLINA THIS AMENDMENT, made and entered into this the 30th day of November, 2015, by and between the County of Orange, a body politic and corporate of the State of North Carolina, ("County"), and The North Carolina Public Health Foundation("Provider"); WITNESSETH: WHEREAS, the County and Provider entered into a Services Agreement dated, May 1, 2014, to provide services to be rendered by Provider to County's Health Department("Original Agreement"); and WHEREAS, the County and Provider desire to amend the Original Agreement, while keeping in effect all terms and conditions of the Original Agreement not inconsistent with the terms and conditions set forth below. NOW THEREFORE, for and in consideration for the mutual covenants and agreements made herein, the parties agree to amend the Original Agreement as follows: Exhibit A: Cost Sharing Agreement for Quitline NC Comprehensive Services Pricing structure Nicotine Replacement Unit Costs 4 weeks 8 weeks Patches $48.00 per shipment $48.00 $96.00 Gum $30.00 per box $90.00 $150.00 Lozenges $38.00 per box $152.00 $190.00 Combination Therapy-4 weeks $108 per first 4 weeks $108.00 $156.00 patches and two boxes of gum $48 per second 4 weeks Combination Therapy-4 weeks $124 per first 4 weeks $124.00 $172.00 patches and two boxes of lozenges $48 per second 4 weeks Except for the changes made to Exhibit A, Cost Sharing Agreement for Quitline NC Comprehensive Services herein, the Original Agreement shall remain in full force and effect to the extent it is not inconsistent with this Amendment. In the event that there is a conflict between the Original Agreement and this Amendment, this Amendment shall control. IN WITNESS WHEREOF, Orange County and the Consultant have signed this Amendment, effective this the 30th day of November, 2015. FO' 0,' 4 iNGG:COUNTY Vag yap.VIDER: 1561Akuit, tka"mt-IrStui It f jv't ) A411 BY onn]9_94B75F477 By. `--- F6u5c 0,e,b64`E... County Manager uc Bridger, MA, Executive Director The North Carolina Public Health Foundation Revised July 2015 DocuSign Envelope ID:4C485144-3EA1-4A86-8777-0808354A83DE Exhibit A Cost Sharing Agreement for QuitlineNC Comprehensive Services Introduction The North Carolina tobacco and Prevention and Control Branch (TPCB") of the North Carolina Division of Public Health in the North Carolina Department of Health and Human Services ("DHHS") works with diverse communities to reduce tobacco disease, death and health care costs. The North Carolina Tobacco-Use Quitline ("QuitlineNC"), funded by TCPB, employs scientific evidence-based methods to help tobacco users quit smoking. The North Carolina Public Health Foundation ("PHF") has entered into a Memorandum of Agreement with TPCB to enable third-parties to enter into cost-sharing agreements with the PHF for Quitline services. The Orange County Health Department has expressed interest in becoming a third party payer to expand the sources of payment for purchase Nicotine Replacement Therapy for Orange County residents enrolled in the QuitlineNC. The following represents a proposal for service delivery between the Orange County Health Department and the NC Public Health Foundation (PHF). General Demographic Information The Orange County Health Department requests Quitline NC provide Nicotine Replacement Therapy for residents of Orange County, North Carolina. There are approximately 133,800 residents, of which approximately [16% (n=21,408)] are tobacco users. Based on historical trends in 2012 and 2013, the projected "reach" or number of residents expected to call the QuitlineNC for services is 220 per year. Eligible service users are Orange County residents who are 18 years or older. Cessation Service for Orange County Residents During the period June 1, 2014 — June 30, 2016, Orange County residents that enroll in the Quitline will receive telephone-based and integrated web-based counseling or web only counseling and free Nicotine Replacement Therapy (NRT) as follows: an initial telephone screening call, four or eight of weeks of free nicotine patches, gum, lozenges or combination therapy, up to four counseling calls per member, mailed materials, and unlimited courtesy calls to the Orange County participant for additional Quitline support. QuitlineNC participants must speak with a coach to receive free NRT. The Orange County Health Department will also be able to take advantage of any statewide or nationwide promotion of 1-800- QuitNow. Per the Memorandum of Agreement between PHF and the DHHS (see Contract Number 00030671, Scope of Services), specific service delivery protocol by QuitlineNC will be as follows: • Initial screening to determine Orange County participant smoking status, provide service explanation and offer counseling; initial counseling call may be completed "on the spot" if a counselor is available; otherwise an appointment will be made for a date and time selected by the Orange County participant. QuitlineNC will initiate the counseling call at the scheduled time. If the Orange County participant is not reached within a total of four (4) call backs, other attempts will be made to try to reach the Orange County participant to complete the engagement. • Up to four (4) telephone counseling sessions (one 45 minute session and three 15 minute sessions) Revised 12/8/15 1 DocuSign Envelope ID:4C485144-3EA1-4A86-8777-0808354A83DE Exhibit A • Eight weeks of nicotine replacement therapy (NRT), based on participation in counseling sessions: four weeks sent to the Orange County participant home address via UPS upon completion of the first telephone counseling call (45 min.) and an additional 4 weeks sent via UPS if the Orange County Health Department participant completes second counseling call. OR • Four weeks of NRT sent to Orange County participant home address via UPS upon completion of the first telephone counseling call. • An information packet which includes a quit tobacco use guide will be mailed to all participants completing the screener call. Those who complete the first counseling call and are approved for NRT will also receive simplified instructions along with the NRT kit. QuitlineNC Reports The Orange County Health Department has requested the following reports: • Monthly aggregate report on services provided, corresponding costs paid with funds from Orange County Health Department, and remaining balance of funds. Report includes # of Orange County participants served, by month and year to date, as well as demographics information, services offered, and amount and type of NRT sent to participants. Costs for Services, Protocol/Database Changes,Verification,and utco a Evaluation Alere Wellbeing, Inc. ("Alere") is the prime vendor to QuitlineNC. Alere, while contracted with the TPCB, will provide QuitlineNC services, including up to 8 weeks of Nicotine Replacement Therapy, at State specific unit cost rates. This is a cost-sharing agreement, whereby selected services will be paid by the Orange County Health Department, while other services will be provided by the TPCB at no cost to the Orange County Health Department, as shown below: Pricing structure Nicotine Replacement Unit Costs 4 weeks 8 weeks Patches $48.00 per shipment $48.00 $96.00 Gum $30.00 per box $90.00 $150.00 Lozenges $38.00 per box $152.00 $190.00 Combination Therapy - 4 $108 per first 4 weeks $108.00 $156.00 wks patches and two boxes $48 per second 4 weeks of gum Combination Therapy - 4 $124 per first 4 weeks $124.00 $172.00 wks patches and two boxes $48 per second 4 weeks of lozenges In addition, an Administrative fee equal to 5% of the total contract price will be charged for the cost of administrative services including the monthly cost and aggregate service reports. 2 DocuSign Envelope ID:4C485144-3EA1-4A86-8777-0808354A83DE Exhibit A Promotional evelo ent The Orange County Health Department agrees to partner with TPCB to initiate promotional development for roll-out of the project. This will be done on an interim basis. TPCB will let Orange County Health Department know of any statewide or nationwide media campaigns that will reach Orange County residents. Payment for Services The Orange County Health Department will pay directly to Public Health Foundations ("PHF") for participant services and for the administration fees which include monthly reporting. Orange County Health Department will make advance payment for contracted services to: NC Public Health Foundation PO Box 18763 Raleigh, NC 27619 3