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DocuSign Envelope ID: 58D1CF8D-AFE2-4E9F-83A1-A478FC8BEB36 <br /> STATE OF NORTH CAROLINA UNCH##92 <br /> COUNTY OF ORANGE <br /> AGREEMENT BETWEEN THE UNIVERSITY OF NORTH CAROLINA HOSPITALS <br /> AND ORANGE COUNTY,NORTH CAROLINA <br /> THIS AGREEMENT, made and entered into this the 1st day of July, 2015 by and between <br /> Orange County("County")by and through the Orange County Department of Social Services("OCDSS") <br /> and The University of North Carolina Hospitals, ("UNCH") in Orange County,North Carolina. <br /> WITNESSETH: <br /> WHEREAS, the parties have agreed with each other that the County will provide certain services <br /> for The University of North Carolina Hospitals in connection with the Orange County Department of <br /> Social Services(hereinafter referred to as OCDSS), Medicaid Program; and <br /> WHEREAS, the UNCH has agreed to pay certain compensation for said service and the parties <br /> desire to execute this contract to delineate their understanding of this agreement; <br /> NOW, THEREFORE,the parties hereby agree as follows: <br /> 1. Term. The term of this Agreement shall be from July 1, 2015 to June 30, 2016. <br /> 2. The County agrees to the following: <br /> a. Scope of Services: The County agrees to provide UNCH the services of one full time <br /> Income Maintenance Caseworker and one part-time supervisor providing up to 10 hours <br /> of supervision a week. <br /> i. The Income Maintenance Caseworker shall receive all potential medical <br /> assistance applications originating at UNCH. Specifically, the Income <br /> Maintenance Caseworker shall perform intake and processing functions on MPW <br /> and MIC applications for Orange County and intake functions only for all other <br /> applications, consisting of the following: conducting interviews that initiate an <br /> application; obtaining signatures; obtaining documentation available at the time <br /> of interview; forwarding applications to the appropriate county for processing; <br /> meeting verification requirements, processing and data entry timeframes, and <br /> sending appropriate notices timely in all processing functions. <br /> ii. The Income Maintenance Caseworker shall be assisted by UNCH staff in <br /> obtaining information and documentation required to complete the application <br /> process. <br /> iii. The Income Maintenance Caseworker shall work cooperatively with UNCH staff <br /> and the staff of any Department of Social Services to make appropriate referrals <br /> of patients and family members with problems not related to eligibility <br /> determination. <br /> iv. The Income Maintenance Worker is an employee of the County and will be <br /> directly supervised by and accountable to OCDSS. Due to the nature of this <br /> agreement and the working relationship with UNCH, it is necessary that close <br />