HomeMy WebLinkAbout2018-358-E Health - Piedmont Health Services WIC agreementDocuSign Envelope ID: 479CCDE6- 7805- 4D93- 82FB- D6EDOCEE182C
PHS /OCHD Memo of Agreement
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 2018 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
patients /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, Eleven dollars ($11) 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 II requirements.
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DocuSign Envelope ID: 479CCDE6- 7805- 4D93- 82FB- D6EDOCEE182C
PHS /OCHD Memo of Agreement
B. OCHD agrees to perform in a manner satisfactory to PHS the following responsibilities:
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, 2018 and ending June 30, 2019.
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.
a. Governing Law. 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 and the Orange County Non - Discrimination
Policy and Orange County Living Wage Policy (each policy is incorporated herein by
reference and may be viewed at
http: / /www.orangecountync.gov/ departments / purchasing _division /contracts.php). Any
violation of this requirement is a breach of this Agreement and County may immediately
terminate this Agreement without further obligation on the part of the County. This
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DocuSign Envelope ID: 479CCDE6- 7805- 4D93- 82FB- D6EDOCEE182C
PHS /OCHD Memo of Agreement
paragraph is not intended to limit and does not limit the definition of breach to
discrimination. 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. By executing this Agreement Provider
certifies that Provider has not been identified, and has not utilized the services of any
agent or subcontractor, on the list created by the State Treasurer pursuant to G.S. 147-
86.58. By executing this Agreement Provider certifies that Provider has not been
identified, and has not utilized the services of any agent or subcontractor identified, on
the list created by the State Treasurer pursuant to G. S. 147 - 86.81.
G. Confidentiality of Patient Records. 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, the
Orange County Non - Discrimination Policy and all other applicable State and Federal
laws regarding employment. Standards for being served by the WIC Program are the
same for all people no matter what race, color, national origin, age, handicap or sex. Any
violation of this requirement is a breach of this Agreement and County may immediately
terminate this Agreement without further obligation on the part of the County. This
paragraph is not intended to limit and does not limit the definition of breach to
discrimination.
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
Attention: Accounts Payable
300 West Tryon Street
Hillsborough, NC 27278
Piedmont Health Services, Inc.
Attention: Brian Toomey
127 Kingston Dr.
Chapel Hill NC, 27514
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.
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DocuSign Envelope ID: 479CCDE6- 7805- 4D93- 82FB- D6EDOCEE182C
PHS /OCHD Memo of Agreement
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.
E DocuSigned by:
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Brian Toomey, Executive Director
Piedmont Health Services, Inc.
.a DocuSigned by:
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Bonnie Hammersley, County Manager
Orange County
0
8/3/2018
Date
8/7/2018
Date