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DocuSign Envelope ID: BA2C9714-6E23-4C44-906C-9D17CC0719D6 UNC SOM#22-0715 <br /> Orange County Managed Care Funds Performance Agreement, Exhibit A <br /> EXHIBIT"A" <br /> Managed Care(Maintenance of Effort)Funds <br /> Scope of Work Statement and Program Budget—FY 2021-2022 <br /> Agency Name: UNC Dept of Psychiatry <br /> Program Name:Center for Excellence in Community Mental Health <br /> Funding Award: $25,000 <br /> I. Budget. Outline how the agency will spend Orange County's funding award. Please attach <br /> additional sheets as necessary to provide detailed budget outline. <br /> Expense Description Amount <br /> Salary support for clinician providing psychiatric services in Orange Co. Jail $25,000 <br /> II. Program Services <br /> Outline the critical services(activities)the agency will employ to attain the Anticipated Outcomes below,by June 30,2022. <br /> • Diagnosic assessments, medication management services for clients in Orange county Jail <br /> III. Anticipated Outcomes <br /> The Anticipated Results column must include quantifiable results in the form of number of persons/units served within Orange <br /> County,only.If you use percentages,you must also provide the total number of participants within that measure's description or <br /> for an earlier performance measure. * <br /> Performance Measures Anticipated <br /> Results <br /> Approximatelt 4-5 visits per week. 200 individuals per year. 200 <br /> * Please atta d itio al s / <br /> Certified by: Title: ate: <br /> ( rovtder's Signature) <br />