Orange County NC Website
Browse       Search
Agreement with OCEHS for Dental Services �i f <br /> FY 2012-13 <br /> AGREEMENT BETWEEN <br /> ORANGE COUNTY HEALTH DEPARTMENT <br /> AND <br /> CHAPEL HILL TRAINING AND OUTREACH, INC., <br /> FOR DENTAL SERVICES FOR ORANGE COUNTY HEAD START AND EARLY HEAD START <br /> THIS AGREEMENT made and entered into on the 1't day of September, 2012 by and between <br /> The Orange County Health Department hereinafter referred to as"OCHD"for its Dental Health Services <br /> Division; and the Orange County Head Start/Early Head Start Program of the Chapel Hill Training and <br /> Outreach Inc., hereinafter referred to as "OCHS/EHS". <br /> WITNESSETH <br /> WHEREAS, OCHS/EHS desires the services of a dentist(s)licensed by the State of North <br /> Carolina with experience or training in children's dentistry, and <br /> WHEREAS, the Health Coordinator of OCHS/EHS and the Director of Dental Health <br /> Services, OCHD shall administer this program and, <br /> WHEREAS, OCHD desires to contract with OCHS/EHS to provide a dentist(s)licensed by the <br /> State of North Carolina to provide services and to serve as a consultant to OCHS/EHS; <br /> NOW THEREFORE, in consideration of the premises and of the following mutual <br /> promises, covenants and conditions, OCHD and OCHS/EHS agree as follows: <br /> 1. OCHD shall provide a dentist(s)licensed to practice in the State of North Carolina to be available <br /> to OCHS/EHS to serve as a consultant, and to provide dental services to the children enrolled at <br /> OCHS/EHS who do not have a dental home. A full examination is required within 90 days of <br /> enrollment; that examination will be conducted at the OCHD Hillsborough dental services site. <br /> 2. OCHD will provide treatment services: <br /> A) Examination <br /> B)Needed extractions <br /> C) Needed restoration including pulp therapy and stainless steel crowns <br /> D)Prophylaxis and topical fluoride application where indicated <br /> E)Provide follow-up documentation of dental exams and treatment on each child <br /> F) Referral of children with severe need to UNC School of Dentistry for evaluation and <br /> possible acceptance for treatment <br /> 3. OCHD will complete the CAP-H.S.S.-30 forms pertaining to dental health and return the forms <br /> to OCHS/EHS to be made a part of the child's permanent Head Start record within one week of the <br /> exam. <br /> 4. OCHD will file for Medicaid/other third party insurance plans for reimbursement when <br /> necessary(OCHS/EHS is not a health provider, therefore cannot file). <br /> 5. OCHD will submit a bill to Angela Wilcox, Director, OCHS/EHS, in the amount of$1500 on an <br /> annual basis by June 30, 2013. The dental services will include dental exams and follow-up services <br /> needed for 10-15 Head Start children who do not have a dental home and are eligible for Medicaid. The <br /> check should be made payable to Orange County Health Department and mailed to-.l ie-I=angstcn, <br /> Financial &Administrative Operation Director, PO Box 8181, Hillsborough, NC. (7*yiS}� efOOSIle'r <br /> 6. OCHS/EHS agrees as follows: <br /> a.Two weeks in advance, coordinate with OCHD to schedule appointments for children needing <br /> S:\Managers Working Files\Contracts\Dental\FY 11-12 Head Start Dental Contract.doc <br />