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HomeMy WebLinkAbout2016-590-E County Mgr - UNC Hospitals for substance abuse counseling DocuSign Envelope ID:887F5093-0A4D-497B-B4F7-702D1 E76D390 NORTH CAROLINA SERVICES AGREEMENT ORANGE COUNTY This Services Agreement(hereinafter"Agreement") is made and entered into this 1st day of September, 2016 ("Effective Date") by and between Orange County, North Carolina a political subdivision of the State of North Carolina, for and on behalf of its Misdemeanor Diversion Program" (hereinafter, the "County") and the University of North Carolina Hospitals, on behalf of its Alcohol and Substance Abuse Program(the "Provider" or"ASAP"). Background: Orange County has developed a Misdemeanor Diversion Program ("MDP"). The MDP is designed to serve 16 and 17 year old first time misdemeanor offenders who would otherwise be referred to traditional District Court. Instead of being referred to District Court, eligible youth will be referred to a court session with the MDP and referred to youth-serving programs in the community. The MDP was approved by the 15B Judicial District Executive Committee and Orange County law enforcement agencies. A description of the MDP is attached to this Agreement as Exhibit A. UNC Hospitals is located in Orange County and believes that early intervention in teenagers with substance abuse is an important component of MDP. Accordingly, UNC Hospitals has agreed to participate in the MDP and provide substance abuse treatment services as further set forth herein. 1. Scope of Work. The MDP will refer appropriate individuals to ASAP. ASAP will provide the following services: a. Provide acknowledgement to MDP when a new MDP client referral is received; b. Notify MDP within 3 business days whether ASAP is able to accept the new MDP client; c. Subject to federal and state privacy law, notify MDP if any problems arise with the new MDP client; d. Subject to permission of the client (which will be required for MDP compliance), notify MDP within 3 business upon the patient's completion of the ASAP program or termination from the ASAP program. e. ASAP will provide up to 8 sessions of group therapy to individuals accepted into the ASAP program under this Agreement. 2. Relationship with Provider. MDP understands that once ASAP accepts an individual referred by MDP, that individual becomes an ASAP patient. Except as specifically set forth herein, ASAP will follow its standard policies and procedures while providing services under this Agreement. All individuals accepted into ASAP's program under this Agreement will have the same privacy rights as all other ASAP patients. ASAP will not disclose any patient information to MDP except as authorized by the patient or under applicable law, including 42 CFR Part 2. MDP will obtain the written permission of all individuals accepted into ASAP's 1 DocuSign Envelope ID:887F5093-0A4D-497B-B4F7-702D1 E76D390 program to allow ASAP to disclose the individual's attendance at ASAP sessions for invoice purposes. In the event the MDP terminates an individual's participation in the MDP, MDP will immediately notify ASAP, and ASAP will no longer provide services to that individual under this Agreement. 3. MDP Responsibilities. MDP will provide ASAP with a referral form that includes relevant client information, including medical and payment information when available. In addition, MDP will pay ASAP the fee of$120 per case accepted by ASAP. The amount of the fee will not vary based upon the amount of services provided by ASAP to MDP as long as ASAP provided at least one therapy session to the individual. The MDP understands that ASAP will pay all third party payors, including private insurance payors and governmental payors such as Medicaid. ASAP will not consider the existence of a third party payor when deciding whether to accept a referral of a MDP client and will base such decisions on clinical information only. Due to the nature and purpose of MDP, ASAP agrees that it will waive all amounts that would otherwise be the responsibility of the patient or the patient's family, including without limitation copays. 4. Confidentiality. Except as otherwise subject to North Carolina Public Records Law ASAP will treat all records relating to the services it provides under this Agreement as confidential patient records. MDP understands that ASAP will maintain all records related to the services it provides under this Agreement as it would all other patient records and those records will be stored in ASAP's electronic medical record system. Patient participation in MDP should remain confidential. 5. Duration of Services. This Agreement will continue until terminated by either party. Either party may terminate this Agreement at any time upon written notice to the other party. In the event of a termination, all individuals already accepted by ASAP under referral by MDP will continue to be subject to this Agreement. 6. Amendments. Any amendment to this Agreement shall not be valid unless made in a writing signed by both parties. 7. Indemnification. Provider will be responsible for its own negligence and the negligence of its employees. 8. Additional Provisions. The County, through MDP, and the Provider each bind themselves, their successors, assigns and legal representatives to the terms of this Agreement. Neither the County, through MDP, nor the Provider shall assign or transfer its interest in this Agreement without the written consent of the other. This Agreement and the duties, responsibilities, obligations and rights of respective parties hereunder shall be governed by the laws of the State of North Carolina. Provider shall at all times remain in compliance with all applicable local, state, and federal laws, rules, and regulations including but not limited to all anti- discrimination laws. By executing this Agreement Provider affirms that Provider and any subcontractors of Provider are and shall remain in compliance with Article 2 of Chapter 64 of the North Carolina General Statutes and that they certify they have not been identified nor utilized the services of any subcontractor on the list created by the State Treasurer pursuant to G.S. § 147-86.58. If any provision of this Agreement is held as a matter of law to be unenforceable, the remainder of this Agreement shall be valid and binding upon the Parties. 2 DocuSign Envelope ID:887F5093-0A4D-497B-B4F7-702D1 E76D390 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. ORANGE COUNTY: PROVIDER: DocuSigned by: e.—DocuSigned by: By: °Ubkkuit, hootAtIrStu By: brim& a,41,Sf qn, County Mana 637994B755E477-. Brian Goldsteh El -Hospitals This instrument has been preaudited in the manner required by the Local Government Budget and Fiscal Control Act �—DocuSigned by: (714,N SZLIAZZon- Orange County ief$F ial Officer 3