2016-520 Health - UNC Faculty Physicians for services related to BCCCP program

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UNC FACULTY THE UNIVERSITY PHYSICTANS of NORTH CAROLINA At CHAPEL HILL POST OFFICE BOX 168 Exhibit A CHAPEL HILL,NC 27514-0168 NC Breast and Cervical Cancer Program This Letter of Agreement between our respective organizations outlines the reimbursement terms and conditions whereby UNC Faculty Physicians (UNC FP) will provide services related to breast and cervical cancer screening for patients as referred by the Orange County Health Department (OCHD). This letter will cover services provided on dates of service between July 1, 2016 and June 30, 2017. UNC FP shall comply with State regulations and local medical standards. For these services, UNC FP agrees to accept as payment in full reimbursement rates as outlined on the "North Carolina Breast and Cervical Cancer Control Program 2016-2017 Services Fee Schedule" (Fee Schedule) attached hereto as Exhibit B. Hospital services, if any, are excluded from this agreement, as are any services provided by UNC FP that are not listed on the Fee Schedule. UNC FP further agrees to seek payment only from the OCHD and will not seek payment from individual patients for services covered under this agreement. OCHD and UNC FP agree that UNC FP is an independent contractor and shall not represent itself as an agent or employee of OCHD for any purpose in the performance of UNC FP's duties under this contract. To the extent permitted by the NC Tort Claims Act, the UNC FP shall indemnify and hold harmless the OCHD, its officials, agents, and employees from and against all claims, damages, losses, and expenses, (including but not limited to fees and charges of attorneys and other professionals and costs related to court action or arbitration) arising out of or resulting from the performance of this agreement or the actions of the UNC FP or its officials, employees, or contractors under this agreement. This indemnification shall survive the termination of this agreement. UNC FP represents that it is in compliance with all applicable Federal, State, and local laws, regulations or orders, as amended or supplemented. The implementation of this contract will be carried out in strict compliance with all Federal, State,or local laws. If applicable, UNC FP shall comply with HIPAA Privacy rules effective April 2003 and HIPAA Security regulations and guidelines effective February 2005. Either party may terminate this agreement by giving thirty(30) days written notice to the other party. OCHD will notify Ann Hornback of patients being referred to UNC as part of this program. Identification will occur preferably by email, or otherwise phone, to: UNC Hospitals—Gynecology Oncology Clinic Ann Hornback, Nurse Manager * (984) 974-9032 *(984) 974-9673 Ann.Hornback@unchealth.unc.edu