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Home My WebLink About2021-377-Health-Piedmont Health Services WIC agreement-Reimbursement for WIC Hemoglobin TestingPHS/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 2021 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. This fee is the fee charged to non-insured patients according to OCHD’s fee schedule. DocuSign Envelope ID: 00894B28-F992-4A97-B495-DAF0B8146F7C PHS/OCHD Memo of Agreement 2 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. 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, 2021 and ending June 30, 2022. 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 pu rposes 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, DocuSign Envelope ID: 00894B28-F992-4A97-B495-DAF0B8146F7C PHS/OCHD Memo of Agreement 3 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 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 88 Villcom Cntr. Dr., Ste 110 Hillsborough, NC 27278 Chapel Hill NC, 27514 DocuSign Envelope ID: 00894B28-F992-4A97-B495-DAF0B8146F7C PHS/OCHD Memo of Agreement 4 l. 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 Director Date Piedmont Health Services, Inc. ______________________________________ ____________ Bonnie Hammersley, County Manager Date Orange County DocuSign Envelope ID: 00894B28-F992-4A97-B495-DAF0B8146F7C 7/7/2021 7/8/2021 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: 88 Villcom Cntr. Dr., Ste 110 City Chapel Hill State: NC Zip: 27514 Department: Health Amount: $3,000 Purpose: Reimbursement for WIC Hemoglobin Testing Budget Code(s): 10414001-476020-71403 - This is a contract for Piedmont to pay us. Vendor # 27898 (N/A if new vendor) Vendor is a BOCC consultant? Yes No Contract Type: (Check one) New Renewal Amendment Effective Date 7/1/21 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: 1 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 the Clerk upon completion: occlerkdocs@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: 00894B28-F992-4A97-B495-DAF0B8146F7C 7/7/2021 7/7/2021 7/8/2021 7/8/2021 6+28/'$1<2)7+($%29('(6&5,%('32/,&,(6%(&$1&(//('%()25( 7+( (;3,5$7,21 '$7( 7+(5(2) 127,&( :,// %( '(/,9(5(' ,1 $&&25'$1&(:,7+7+(32/,&<3529,6,216 ,1685(56$))25',1*&29(5$*( ,1685(5) ,1685(5( ,1685(5' ,1685(5& ,1685(5% ,1685(5$ 1$,& 1$0(&217$&7 $&1R)$; (0$,/$''5(66 352'8&(5 $&1R([W3+21( ,1685(' 5(9,6,21180%(5&(57,),&$7(180%(5&29(5$*(6 ,03257$17,IWKHFHUWLILFDWHKROGHULVDQ$'',7,21$/,1685('WKHSROLF\LHVPXVWKDYH$'',7,21$/,1685('SURYLVLRQVRUEHHQGRUVHG ,I68%52*$7,21,6:$,9('VXEMHFWWRWKHWHUPVDQGFRQGLWLRQVRIWKHSROLF\FHUWDLQSROLFLHVPD\UHTXLUHDQHQGRUVHPHQW$VWDWHPHQWRQ WKLVFHUWLILFDWHGRHVQRWFRQIHUULJKWVWRWKHFHUWLILFDWHKROGHULQOLHXRIVXFKHQGRUVHPHQWV 7+,6&(57,),&$7(,6,668('$6$0$77(52),1)250$7,2121/<$1'&21)(56125,*+7683217+(&(57,),&$7(+2/'(57+,6 &(57,),&$7( '2(6 127 $)),50$7,9(/< 25 1(*$7,9(/< $0(1' (;7(1' 25 $/7(5 7+( &29(5$*( $))25'(' %< 7+( 32/,&,(6 %(/2: 7+,6 &(57,),&$7( 2) ,1685$1&( '2(6 127 &2167,787( $ &2175$&7 %(7:((1 7+( ,668,1* ,1685(56 $87+25,=(' 5(35(6(17$7,9(25352'8&(5$1'7+(&(57,),&$7(+2/'(5 27+(5 3HUDFFLGHQW (DDFFLGHQW 1$ 68%5 :9' $''/ ,16' 7+,6,672&(57,)<7+$77+(32/,&,(62),1685$1&(/,67('%(/2:+$9(%((1,668('727+(,1685('1$0('$%29()257+(32/,&<3(5,2' ,1',&$7('127:,7+67$1',1*$1<5(48,5(0(177(5025&21',7,212)$1<&2175$&72527+(5'2&80(17:,7+5(63(&772:+,&+7+,6 &(57,),&$7( 0$< %( ,668(' 25 0$< 3(57$,1 7+( ,1685$1&( $))25'(' %< 7+( 32/,&,(6 '(6&5,%(' +(5(,1 ,6 68%-(&7 72 $// 7+( 7(506 (;&/86,216$1'&21',7,2162)68&+32/,&,(6/,0,766+2:10$<+$9(%((15('8&('%<3$,'&/$,06 3523(57<'$0$*( %2',/<,1-85<3HUDFFLGHQW %2',/<,1-85<3HUSHUVRQ &20%,1('6,1*/(/,0,7 $872621/< $8726$872621/<1212:1(' 6&+('8/('2:1(' $1<$872 $87202%,/(/,$%,/,7< <1 :25.(56&203(16$7,21 $1'(03/2<(56 /,$%,/,7< 2)),&(50(0%(5(;&/8'('" 0DQGDWRU\LQ1+ '(6&5,37,212)23(5$7,216EHORZ ,I\HVGHVFULEHXQGHU $1<35235,(7253$571(5(;(&87,9( (/',6($6(32/,&</,0,7 (/',6($6(($(03/2<(( (/($&+$&&,'(17 (527+67$787(3(5 /,0,7600''<<<<32/,&<(;300''<<<<32/,&<())32/,&<180%(57<3(2),1685$1&(/75,165 '(6&5,37,212)23(5$7,216/2&$7,2169(+,&/(6$&25'$GGLWLRQDO5HPDUNV6FKHGXOHPD\EHDWWDFKHGLIPRUHVSDFHLVUHTXLUHG (;&(66/,$% 80%5(//$/,$%($&+2&&855(1&( $**5(*$7( 2&&85 &/$,060$'( '(' 5(7(17,21 352'8&76&20323$** *(1(5$/$**5(*$7( 3(5621$/ $'9,1-85< 0('(;3$Q\RQHSHUVRQ ($&+2&&855(1&( '$0$*(725(17('35(0,6(6(DRFFXUUHQFH &200(5&,$/*(1(5$//,$%,/,7< &/$,060$'( 2&&85 *(1 /$**5(*$7(/,0,7$33/,(63(5 32/,&<352-(&7 /2& &(57,),&$7(2)/,$%,/,7<,1685$1&('$7(00''<<<< &$1&(//$7,21 $87+25,=('5(35(6(17$7,9( $&25' $&25'&25325$7,21$OOULJKWVUHVHUYHG &(57,),&$7(+2/'(5 7KH$&25'QDPHDQGORJRDUHUHJLVWHUHGPDUNVRI$&25' +,5(' $872621/< DocuSign Envelope ID: 00894B28-F992-4A97-B495-DAF0B8146F7C $&25' 7KH$&25'QDPHDQGORJRDUHUHJLVWHUHGPDUNVRI$&25' $&25'&25325$7,21$OOULJKWVUHVHUYHG 7+,6$'',7,21$/5(0$5.6)250,6$6&+('8/(72$&25')250 )250180%(5)2507,7/( $'',7,21$/5(0$5.6 $'',7,21$/5(0$5.66&+('8/(3DJHRI $*(1&<&86720(5,' /2& $*(1&< &$55,(5 1$,&&2'( 32/,&<180%(5 1$0(',1685(' ())(&7,9('$7( DocuSign Envelope ID: 00894B28-F992-4A97-B495-DAF0B8146F7C