2011-330 Health - Chapel Hill Training and Outreach, Inc. for dental services for Head Start, Early Head Start program

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I Agreement with OCEHS for Dental Services FY 2011-2012 4. OCHD will provide educational services which may include but not be limited to the following: A) Dental health education for children B) Dental health education for parents, including meeting with a dental staff member and individual parents of children requiring follow-up treatment C) Dental health education for staff D)Suggestions for classroom activities E) Hand-outs to be taken home by the children 5. OCHD will complete the CAP-H.S.S.-30 forms pertaining to dental health and return the forms to OCHS/EHS to be made a part of the child's permanent Head Start record. 6. OCHD will file for Medicaid/other third party insurance plans for reimbursement when necessary(OCHS/EHS is not a health provider, therefore cannot file). 7. OCHD will submit a bill to Angela Wilcox, Director, OCHS/EHS, in the amount of$4,000 on an annual basis. OCHS/EHS agrees to pay the OCHD in two installments, $2,000 by December 31, 2011 and the remaining $2,000 by June 30, 2012, upon receipt of OCHD original invoice. The dental services will include initial screenings to five OCHS classrooms to a total of 80 children and dental exams and follow-up services needed for 20-25 Head Start children who do not have a dental home and are eligible for Medicaid. The check should be made payable to Orange County Health Department and mailed to Erin Langston, Financial &Administrative Operation Director, PO Box 8181, Hillsborough, NC. 8. OCHS/EHS agrees as follows: a. To transport no more than 5-10 children at a time to be scheduled in a block of time and to provide adequate supervision in the waiting room. OCHS/EHS shall be responsible for obtaining and maintaining adequate automobile liability insurance as required by law and if requested will furnish to the County certificates of such insurance. b. To arrive for the scheduled appointments on-time with all children scheduled for that day. OCHS/EHS shall be responsible for re-scheduling any appointments unable to be met at least 24 hours in advance. C. To provide necessary parental permissions, information for the Eligibility Determination forms, and the Medical and Dental Histories for each child prior to that child undergoing treatment. OCHS/EHS will bring all signed forms on the day of service. d. To provide CAP-H.S.S.-30 forms pertaining to dental health and will make the completed form a part of the child's permanent OCHS/EHS record. e. To obtain a copy of each child's Medicaid card or other dental insurance and bring a copy to the OCHD on the scheduled day of service. 9. In the event that enrollment in OCHS/EHS program ceases or is significantly reduced during the term of this agreement, OCHS/EHS may terminate this agreement upon 30 days notice and OCHD will return a pro rata share of the payment for services not provided (approximately$100 per enrolled child for those children whose dental work has not been started). 10. The parties agree that there shall be no unlawful discrimination based upon race, color, ancestry, national origin, religion, sex, age, disability or veteran status. Page 2 of 4 S:\Managers Working Files\Contracts\Dental\FY 11-12 Head Start Dental Contract.cloc