2015-634-E Health - NC Public Health Foundation for Quit Line Amendment

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DocuSign Envelope ID:4C485144-3EA1-4A86-8777-0808354A83DE Exhibit A Cost Sharing Agreement for QuitlineNC Comprehensive Services Introduction The North Carolina tobacco and Prevention and Control Branch (TPCB") of the North Carolina Division of Public Health in the North Carolina Department of Health and Human Services ("DHHS") works with diverse communities to reduce tobacco disease, death and health care costs. The North Carolina Tobacco-Use Quitline ("QuitlineNC"), funded by TCPB, employs scientific evidence-based methods to help tobacco users quit smoking. The North Carolina Public Health Foundation ("PHF") has entered into a Memorandum of Agreement with TPCB to enable third-parties to enter into cost-sharing agreements with the PHF for Quitline services. The Orange County Health Department has expressed interest in becoming a third party payer to expand the sources of payment for purchase Nicotine Replacement Therapy for Orange County residents enrolled in the QuitlineNC. The following represents a proposal for service delivery between the Orange County Health Department and the NC Public Health Foundation (PHF). General Demographic Information The Orange County Health Department requests Quitline NC provide Nicotine Replacement Therapy for residents of Orange County, North Carolina. There are approximately 133,800 residents, of which approximately [16% (n=21,408)] are tobacco users. Based on historical trends in 2012 and 2013, the projected "reach" or number of residents expected to call the QuitlineNC for services is 220 per year. Eligible service users are Orange County residents who are 18 years or older. Cessation Service for Orange County Residents During the period June 1, 2014 — June 30, 2016, Orange County residents that enroll in the Quitline will receive telephone-based and integrated web-based counseling or web only counseling and free Nicotine Replacement Therapy (NRT) as follows: an initial telephone screening call, four or eight of weeks of free nicotine patches, gum, lozenges or combination therapy, up to four counseling calls per member, mailed materials, and unlimited courtesy calls to the Orange County participant for additional Quitline support. QuitlineNC participants must speak with a coach to receive free NRT. The Orange County Health Department will also be able to take advantage of any statewide or nationwide promotion of 1-800- QuitNow. Per the Memorandum of Agreement between PHF and the DHHS (see Contract Number 00030671, Scope of Services), specific service delivery protocol by QuitlineNC will be as follows: • Initial screening to determine Orange County participant smoking status, provide service explanation and offer counseling; initial counseling call may be completed "on the spot" if a counselor is available; otherwise an appointment will be made for a date and time selected by the Orange County participant. QuitlineNC will initiate the counseling call at the scheduled time. If the Orange County participant is not reached within a total of four (4) call backs, other attempts will be made to try to reach the Orange County participant to complete the engagement. • Up to four (4) telephone counseling sessions (one 45 minute session and three 15 minute sessions) Revised 12/8/15 1