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HomeMy WebLinkAbout2020-702-E-Health-Piedmont Health ServicesPHS/OCHD Memo of Agreement 1 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 2020 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. DocuSign Envelope ID: 8B9EAFDE-602B-4270-B87F-8DFC5B17EB6E PHS/OCHD Memo of Agreement 2 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 reasonable working space in the Chapel Hill office for WIC staff to meet with clients referred by Orange County Health Department. 3. Provide access to Medical Records for the purpose of gathering medical information and for project evaluation. 4. 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. 5. 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, 2020 and ending June 30, 2021. 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 othe r 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. Governing Law and Priority. 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 DocuSign Envelope ID: 8B9EAFDE-602B-4270-B87F-8DFC5B17EB6E PHS/OCHD Memo of Agreement 3 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 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. In determining the basic services to be provided, should any documents be referenced in or attached to this Agreement, the terms herein shall have priority in any conflict between the terms of referenced documents and the terms of this Agreement. H. 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. I. 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. J. 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. K. 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 Piedmont Health Services, Inc. Attention: Accounts Payable Attention: Brian Toomey 300 West Tryon Street 127 Kingston Dr. Hillsborough, NC 27278 Chapel Hill NC, 27514 l. Signatures. This Agreement together with any amendments or modifications may be executed electronically. All electronic signatures affixed hereto evidence the intent of the DocuSign Envelope ID: 8B9EAFDE-602B-4270-B87F-8DFC5B17EB6E PHS/OCHD Memo of Agreement 4 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 Director Date Piedmont Health Services, Inc. ______________________________________ ____________ Bonnie Hammersley, County Manager Date Orange County DocuSign Envelope ID: 8B9EAFDE-602B-4270-B87F-8DFC5B17EB6E 10/6/2020 10/8/2020 PHS/OCHD Memo of Agreement 5 ORANGE COUNTY—DEPARTMENT USE ONLY ______________________________________________________________________________ Department Party/Vendor Name: Piedmont Health Services Party/Vendor Contact Person: Ashley Brewer Contact Phone: 336-382-0242 Party/Vendor Address: 127 Kingston Drive City Chapel Hill State: NC Zip: 27514 Department: Health Amount: $3,000 Purpose: Reimbursement for WIC Hemoglobin Testing Budget Code(s): 10414001- 476020-71403 Vendor # 27898 (N/A if new vendor) Vendor is a BOCC consultant? Yes No Contract Type: (Check one) New Renewal Amendment Effective Date 7/1/20 Approved by Board Yes No Agenda Date: This agreement is approved as to technical form and content and I as Department Director affirmatively state work on this project has not been initiated prior to execution of the agreement: Department Director’s Signature ________________________________________ Date: ________ Agreements for emergency services or repair are not subject to the above affirmation. If services related to this agreement have already begun or been completed please briefly describe the nature of the emergency condition that was addressed: We were waiting on the COI. This is a contract for Piedmont to pay us. Information Technologies (Applicable only to hardware/software purchases or related services) This agreement has been reviewed and is approved as to information technology content and specifications: Office of the Chief Information Officer___________________________________ Date: ________ Risk Management This agreement is approved for sufficiency of insurance standards, specifications, and requirements: Office of the Risk Management Officer___________________________________ Date: _________ Financial Services This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: Office of the Chief Financial Officer ____________________________________ Date: _________ Legal Services This agreement is approved as to legal form and sufficiency: Office of the County Attorney __________________________________________Date: ________ Clerk to the Board Received for record retention: All Docusign contracts must be copied to Sherri Ingersoll upon completion: singersoll@orangecountync.gov The following signature block is for hard copies only and is not required for Docusign contracts: Office of the Clerk to the Board __________________________________________Date:_________ DocuSign Envelope ID: 8B9EAFDE-602B-4270-B87F-8DFC5B17EB6E 10/6/2020 10/7/2020 10/8/2020 10/8/2020 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 8/31/2020 Marsh &McLennan Agency LLC 5605 Carnegie Blvd. Suite 300 Charlotte NC 28209 Christina Luckey,CISR,CLCS 704-556-3329 christina.luckey@marshmma.com AIX Specialty Insurance Company 12833 PIEDMHEAL9 Allmerica Finanical Benefit Insurance 41840PiedmontHealthServicesInc. 127 Kingston Drive Chapel Hill NC 27516 StarNet Insurance Company 40045 1056402395 A X 1,000,000 X 100,000 X 1,000 5,000 1,000,000 3,000,000 X L16A73441104 10/11/2019 10/11/2020 3,000,000 B 1,000,000 X AW6A53452804 10/11/2019 10/11/2020 A X X 5,000,000L16A7344120410/11/2019 10/11/2020 5,000,000 X 0 C XKEY01362922/1/2020 2/1/2021 1,000,000 1,000,000 1,000,000 A PL/AM/EBL L16A73441104 10/11/2019 10/11/2020 LIMIT/DED *SEE BELOW *PROFESSIONAL LIABILITY--- LIMIT $1,000,000 AGGREGATE $3,000,000 DED $1,000 ABUSE OR MOLESTATION--- LIMIT $1,000,000 AGGREGATE $3,000,000 See Attached... Orange County Government Attn:Risk Manager 200 S Cameron Street P O Box 8181 Hillsborough NC 27278 DocuSign Envelope ID: 8B9EAFDE-602B-4270-B87F-8DFC5B17EB6E ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved. THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:FORM TITLE: ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE Page of AGENCY CUSTOMER ID: LOC #: AGENCY CARRIER NAIC CODE POLICY NUMBER NAMED INSURED EFFECTIVE DATE: PIEDMHEAL9 1 1 Marsh &McLennan Agency LLC Piedmont Health Services Inc. 127 Kingston Drive Chapel Hill NC 27516 25 CERTIFICATE OF LIABILITY INSURANCE Orange County,NC,as Designated Organization,is an Additional Insured as respects General &Auto Liability when required by written contract subject to the terms,conditions and exclusions of the policy. DocuSign Envelope ID: 8B9EAFDE-602B-4270-B87F-8DFC5B17EB6E