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Home My WebLink About20051500.tiff RESOLUTION RE: APPROVE PURCHASE OF SERVICES AGREEMENT AND AUTHORIZE CHAIR TO SIGN - MONTROSE COMMUNITY DENTAL CLINIC WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS,the Board has been presented with a Purchase of Services Agreement between the County of Weld,State of Colorado,by and through the Board of County Commissioners of Weld County, on behalf of the Department of Human Services, Family Educational Network of Weld County, and the Montrose Community Dental Clinic, commencing May 2, 2005, and ending November 30, 2005, with further terms and conditions being as stated in said agreement, and WHEREAS,after review,the Board deems it advisable to approve said agreement,a copy of which is attached hereto and incorporated herein by reference. NOW,THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County,Colorado,that the Purchase of Services Agreement between the County of Weld,State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Human Services, Family Educational Network of Weld County, and the Montrose Community Dental Clinic be, and hereby is, approved. BE IT FURTHER RESOLVED by the Board that the Chair be,and hereby is,authorized to sign said agreement. The above and foregoing Resolution was,on motion duly made and seconded,adopted by the following vote on the 16th day of May, A.D., 2005, nunc pro tunc May 2, 2005. IE Las BOARD OF COUNTY COMMISSIONERS MGM( WELD COUNTY, COLORADO ig--L ,v / '• William H. Je e, Chair %On W..'= A ty Clerk to the Board M. . eile, Pro- em BY: (Lc- % 2 eputy Clerk to the Board c Davi E. Long --- 4X19/ED M: Robe . Masd oun Attor ey -57c905— �� Glenn as Date of signature: / a/ /5— 2005-1500 00 ; 1 -t-5 76 C_��S\ HR0 OS-3/-OS- MEMORANDUM a r--- DATE: May 12, 2005 ' TO: Board of County Commissioners � JV I�`p O FROM: Walt Speckman, Executive Director • COLORADO SUBJECT: Purchase of Service Agreement between FENWC and Montrose Community Dental Clinic Presented for approval before the Weld. County Board of County Commissioners is a Purchase of Service Agreement between the Migrant/Seasonal Head Start Program hereinafter referred to as"FENWC" and Montrose Community Dental Clinic hereinafter referred to as"Dentist." The Dentist agrees to provide dental screening/examination for approximately forty-six Migrant/Seasonal Head Start eligible children. Other dental services will be reimbursed according to the Medicaid rate for services. FENWC agrees to arrange transportation for the Migrant/Seasonal Head Start eligible children to the dentist as needed. FENWC agree to reimburse the Dentist $15.00 per child per screening/examination. FENWC will not be charged for those children covered by Medicaid or private insurance. For services not reimbursed by FENWC, the amount will be designated as In-Kind Contribution to the FENWC Program on behalf of the Dentist and will be documented on the bill. The term of this Agreement is May 2, 2.005, through November 30, 2005 with the option to extend to December 30, 2005. If you have any questions please contact Janet Flaugher, Director, @ 353-3800, ext. 3340. 2005-1500 PURCHASE OF SERVICE AGREEMENT THIS AGREEMENT, made and entered into this _ day of May, 2005, by and between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Weld County Division of Human Services' Family Educational Network of Weld County, Migrant/Seasonal Head Start Program, hereinafter referred to as "FENWC" and Montrose Community Dental Clinic hereinafter referred to as "Dentist." WITNESSETH THAT FOR and in consideration of the covenants here in agreed to be kept and performed, the Dentist hereby agrees to provide to FENWC the following described services based upon the following terms and conditions: 1. FENWC agrees to arrange transportation for Head Start children to the dentist as needed. This will enable parents to be transported with their children to attend their child's scheduled appointment at the Dentist's office. 2. FENWC agrees to reimburse the Dentist $15.00 per child per screening/examination for approximately forty-six(46)Migrant/Seasonal Head Start eligible children. Other dental services will be reimbursed according to the Medicaid rate for services. All bills submitted will be itemized according to child and service to: Family Educational Network of Weld County Migrant Head Start Program attn: Health Specialist PO Box 1805 Greeley, CO 80632 4. FENWC will not be charged for those children covered by Medicaid or private insurance. Medicaid numbers shall be provided at the time of the appointment and billing will be sent to the appropriate agency by the Dentist. Head Start is a payer of last resort. 5. For services not reimbursed by FENWC, the amount will be designated as In-Kind Contribution to the FENWC Program on behalf of the Dentist and will be documented on the bill. 6. The term of this Agreement is May 2, 2005 through November 30, 2005 with the option to extend to December 30, 2005. 7. The Dentist assures that it carries adequate liability and malpractice insurance. %os-isoO 8. Assurances: a. The Dentist agrees that he is an independent contractor and that his officers, employees, and clients do not become employees of Weld County, and therefore are not entitled to any employee benefits as Weld County employees, as a result of the execution of this Agreement. b. FENWC, the Weld County Board of Commissioners, its officers and employees, shall not be held liable for injuries or damages caused by any negligent acts or omissions of the Dentist, its employees, volunteers or agents while performing this Agreement. The Dentist, its officers and employees, shall not be held liable for injuries or damages caused by any negligent acts or omissions of FENWC, the Weld County Board of Commissioners, its officers and employees. The respective contracting parties shall provide such liability insurance and worker's compensation coverage as each deems appropriate, and as required by the Colorado Worker's Compensation Act. c. No portion of this Agreement shall be deemed to constitute a waiver of any immunities the parties or their officers or employees may possess, nor shall any portion of this Agreement be deemed to have created a duty of care with respect to any persons not a party to this Agreement. d. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise appropriate in each succeeding year. e. No officer, member, or employee of Weld County, and no member of their governing bodies shall have any pecuniary interest, direct, or indirect in the approved Agreement or the proceeds thereof. f. The Dentist understands that monitoring and evaluation of the performance of this Agreement shall be conducted by the Weld County Division of Human Resources and the results provided to the Weld County Board of Commissioners. g. The Dentist and FENWC assure compliance with Title VI of the Civil Rights Act of 1986, and that no person shall on the grounds of race, creed, color, sex, handicap or national origin be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under the approved Agreement. 9. All modifications to this Agreement shall be in writing and signed by both parties. 10. This Agreement may be terminated by either party giving a thirty (30) days written notice to the other party. If funding to FENWC should cease, this Agreement will terminate immediately. If FENWC funding should be reduced, this Agreement will be renegotiated immediately to reflect funding changes. IN WITNESS WHEREOF, of the parties above hereunto placed their hands as of the date first written above. WELD COUNTY BOARD OF Montrose Community Dental COUNTY COMMISSIONERS Clinic �'l' H. Jerke, Chairperson MAY 1 6 2005 J et Touslee, Executive Director 44 a I 861 t "1 41.411444 L UNTY CLERK TO THE BOARD etat Deputy Clerk fo the Board ec WELD COUNTY DIVISION OF HUMAN SERVICES vV Walt eckman, Executive Director Bois -Zs-GO COMMUNITY DENTAL CLINIC ADDENDUM TO AGREEMENT WITH BUSINESS ASSOCIATE This addendum("Addendum")is effective upon execution,and amends and is made part of dated as of ("Agreement")by and between ("Business Associate") and COMMUNITY DENTAL CLINIC ("Dental Practice). Dental Practice and Business Associate mutually agree to modify Agreement to incorporate the terms of this Addendum to comply with the requirements of the Health Insurance Portability and Accountability Act of 1996 and its implementing regulations(45 C.F.R.Parts 160-64). PRIVACY OF PROTECTED HEALTH INFORMATION 1. Permitted Uses and Disclosures.Business Associate is permitted or required to use or disclose Protected Health Information it creates or receives for or from Dental Practice only as follows: a) Functions and Activities on Dental Practice's Behalf.Business Associate is permitted to use and disclose Protected Health Information it creates or receives for or from Dental Practice(either insert full description of the functions,activities and services to be performed on Dental Practice's behalf,or reference sections of Agreement that specify those functions,activities and services) b) Business Associate's Operations.Business Associate may use Protected Health Information it creates or receives for or from Dental Practice as necessary for Business Associate's proper management and admin- istration or to carry out Business Associate's legal responsibilities. Business Associate may disclose such Protected Health Information as necessary for Business Associate's proper management and administration or to carry out Business Associate's legal responsibilities only if: The disclosure is required by law,or Business Associate obtains reasonable assurance,evidenced by written contract,from any person or organ- ization to which Business Associate will disclose such Protected Health Information that the person or organ- ization will: Hold such Protected Health Information in confidence and use or further disclose it only for the purpose for which Business Associate disclosed it to the person or organization or as required by law,and Notify Business Associate(who will in turn promptly notify Dental Practice)of any instance of which the per- son or organization becomes aware In which the confidentiality of such Protected Health Information was breached. 2. Prohibition on Unauthorized Use or Disclosure.Business Associate will neither use nor disclose Protected Health Information It creates or receives for or from Dental Practice or from another Business Associate of Dental Practice,except as permitted or required by this Addendum or as required by law or as otherwise permit- ted in writing by Dental Practice. A Information Safeguards.Business Associate will develop,Implement,maintain and use appropriate adminis- trative,technical and physical safeguards,in compliance with Social Security Act§ 1173(d)(42 U.S.C.§1320d- 2(d)),45 Code of Federal Regulation§164.530(c)and any other implementing regulations issued by the U.S. Department of Health and Human Services,to preserve the integrity and confidentiality of and to prevent non- permitted or violating use or disclosure of Protected Health Information created or received for or from Dental Practice.Business Associate will document and keep these safeguards current. 4. Sub-contractors and Agents.Business Associate will require any of its subcontractors and agents,to which Business Associate is permitted by this Addendum or in writing by Dental Practice to disclose any of the Protected Health Information Business Associate creates or receives for or from Dental Practice,to provide rea- sonable assurance,evidenced by written contract,that subcontractor or agent will comply with the same privacy and security obligations as Business Associate with respect to such Protected Health Information. Compliance with Standard Transactions. If Business Associate conducts in whole or part Standard Transactions for or on behalf of Dental Practice,Business Associate will comply,and will require any sub- contractor or agent involved with the conduct of such Standard Transactions to comply,with each applicable requirement of 45 Code of Federal Regulations Part 162. PROTECTED HEALTH INFORMATION ACCESS,AMENDMENT AND DISCLOSURE ACCOUNTING Access.Business Associate will promptly upon Dental Practice's request make available to Dental Practice or,at Dental Practice's direction,to the patient(or the patient's personal representative)for inspection and obtaining copies any Protected Health Information about the patient which Business Associate created or received for or from Dental Practice and that is in Business Associate's custody or control,so that Dental Practice may meet its access obligations under 45 Code of Federal Regulations§ 164,524. 5. Amendment Business Associate will, upon receipt of notice from Dental Practice,promptly amend or permit Dental Practice access to amend any portion of the Protected Health Information which Business Associate cre- ated or received for or from Dental Practice,so that Dental Practice may meet Its amendment obligations under 45 Code of Federal Regulations§164.526. a.)Disclosure Accounting.So that Dental Practice may meet its disclosure accounting obligations under 45 Code of Federal Regulations§164.528: Disclosure Tracking.Starting April 14,2003,Business Associate will record for each disclosure,not excepted from disclosure accounting under Addendum Section 5(a)"Exceptions from Disclosure Tracking"below,that Business Associate makes to Dental Practice or a third party of Protected Health Information that Business Associate creates or receives for or from Dental Practice,(I)the disclosure date,(ii)the name and(If known) address of the person or entity to whom Business Associate made the disclosure,(iii)a brief description of the Protected Health Information disclosed,and(iv)a brief statement of the purpose of the disclosure(items I-iv,collectively,the"disclosure information').For repetitive disclosures Business Associate makes to the same person or entity(including Dental Practice)for a single purpose,Business Associate may provide(x) the disclosure information for the first of these repetitive disclosures,(y)the frequency,periodicity or number of these repetitive disclosures and(z)the date of the last of these repetitive disclosures.Business Associate will make this disclosure information available to Dental Practice promptly upon Dental Practice's request. Exceptions from Disclosure Tracking.Business Associate need not record disclosure information or otherwise account for disclosures of Protected Health Information that this Addendum or Dental Practice in writing per- mits or requires(I)for the purpose of Dental Practice's treatment activities,payment activities,or healthcare operations,(ii)to the patient who is the subject of the Protected Health Information disclosed or to that patient's personal representative;(iii)to persons involved in that patient's healthcare or payment for health- care;(iv)for notification for disaster relief purposes,(v)for national security or intelligence purposes,or(vi)to law enforcement officials or correctional institutions regarding inmates. Disclosure Tracking Time Periods. Business Associate must have available for Dental Practice the disclosure information required by Addendum Section 5(a) "Disclosure Tracking"for the 6 years preceding Dental Practice's request for the disclosure information(except Business Associate need have no disclosure infor- mation for disclosures occurring before April 14,2003), 6. Inspection of Books and Records.Business Associate will make its internal practices,books,and records, relating to its use and disclosure of the Protected Health Information it creates or receives for or from Dental Practice,available to Dental Practice and to the U.S.Department of Health and Human Services to determine compliance with 45 Code of Federal Regulations Parts 160.64 or this Addendum. BREACH OF PRIVACY OBLIGATIONS 7. Reporting. Business Associate will report to Dental Practice any use or disclosure of Protected Health Information not permitted by this Addendum.Business Associate will make the report to Dental Practice not less than 24 hours after Business Associate learns of such non-permitted or violating use or disclosure.Business Associate's report will at least: a) Identify the nature of the non-permitted or violating use or disclosure; b) Identify the Protected Health Information used or disclosed; c) Identify who made the non-permitted or violating use or received the non-permitted or violating disclosure; d) Identify what corrective action Business Associate took or will take to prevent further non-permitted or violat- ing uses or disclosures; e) Identify what Business Associate did or will do to mitigate any deleterious effect of the non-permitted or vio- lating use or disclosure;and f) Provide such other information,including a written report,as Dental Practice may reasonably request. 8. Termination of Agreement. a) Right to Terminate for Breach.Dental Practice may terminate Agreement if it determines,in its sole discre- tion,that Business Associate has breached any provision of this Addendum.Dental Practice may exercise this right to terminate Agreement by providing Business Associate written notice of termination,stating the breach of the Addendum that provides the basis for the termination.Any such termination will be effective immediately or at such other date specified in Dental Practice's notice of termination. b) Obligations upon Termination, Return or Destruction. Upon termination,cancellation,expiration or other conclusion of Agreement,Business Associate will,if feasible, return to Dental Practice or destroy all Protected Health Information,in whatever form or medium(including in any electronic medium under Business Associate's custody or control),that Business Associate created or received for or from Dental Practice,including all copies of and any data or compilations derived from and allowing identification of any patient who is a subject of the Protected Health Information.Business Associate will complete such return or destruction as promptly as possible,but not later than 30 days after the effective date of the termination,cancellation,expiration or other conclusion of Agreement.Business Associate will identify any Protected Health Information that Business Associate creat- ed or received for or from Dental Practice that cannot feasibly be returned to Dental Practice or destroyed, and will limit its further use or disclosure of that Protected Health Information to those purposes that make return or destruction of that Protected Health Information infeasible. Within such 30 days, Business Associate will certify on oath in writing to Dental Practice that such return or destruction has been complet- ed,will deliver to Dental Practice the identification of any Protected Health Information for which return or destruction is infeasible and,for that Protected Health Information,will certify that it will only use or disclose such Protected Health Information for those purposes that make return or destruction infeasible. Continuing Privacy Obligation, Business Associate's obligation to protect the privacy of the Protected Health Information it created or received for or from Dental Practice will be continuous and survive termination,can- cellation,expiration or other conclusion of Agreement. 9. Indemnity.Business Associate will indemnify and hold harmless Dental Practice and any Dental Practice affili- ate,officer,director,employee or agent from and against any claim,cause of action, liability,damage,cost or expense,including attorneys'fees and court or proceeding costs,arising out of or in connection with any non- permitted or violating use or disclosure of Protected Health Information or other breach of this Addendum by Business Associate or any subcontractor,agent,person or entity under Business Associate's control. a) Right to Tender or Undertake Defense.If Dental Practice is named a party in any judicial,administrative or other proceeding arising out of or in connection with any non-permitted or violating use or disclosure of Protected Health Information or other breach of this Addendum by Business Associate or any subcontractor, agent, person or entity under Business Associate's control,Dental Practice will have the option at any time either(i)to tender its defense to Business Associate,in which case Business Associate will provide qualified attorneys, consultants and other appropriate professionals to represent Dental Practice's interests at Business Associate's expense,or(ii)undertake its own defense,choosing the attorneys,consultants and other appropriate professionals to represent its interests,in which case Business Associate will be responsi- ble for and pay the reasonable tees and expenses of such attorneys,consultants and other professionals. b) Right to Control Resolution.Dental Practice will have the sole right and discretion to settle,compromise or otherwise resolve any and all claims,causes of actions,liabilities or damages against it,notwithstanding that Dental Practice may have tendered its defense to Business Associate.Any such resolution will not relieve Business Associate of its obligation to indemnify Dental Practice under this Addendum Section g, GENERAL PROVISIONS 10. Definitions.The capitalized terms Protected Health Information"and"Standard Transaction"have the meanings set out in,respectively,45 Code of Federal Regulations§164.501 and 45 Code of Federal Regulations§160.103. 11. Amendment to Agreement.Upon the effective date of any final regulation or amendment to final regula- tions promulgated by the U.S.Department of Health and Human Services with respect to Protected Health Information or Standard Transactions,this Addendum and the Agreement of which it is part will automati- cally amend such that the obligations they impose on Business Associate remain in compliance with these regulations. Conflicts.The terms and conditions of this Addendum will override and control any conflicting term or condition of Agreement.All nonconflicting terms and conditions of Agreement remain in full force and effect. IN WITNESS WHEREOF,Dental Practice and Business Associate execute this Addendum in multiple originals to be effective on the last date written below. . _ A' Weld County Board of Commissioners- (Jrz41l 1Lii'it(,/ 7JP,((_�CU ( iLlU_C Business Associate's Name Dental Practice's name _/I_/1If� By William H. Jerke, Chair Its: y Its: U Date: MAY 16 2005 Date: ,� F OD N1 I:_:.)1: E11,4),,, WELD COUNTY CLERK TOT BOAR', n* Err: 186! •LTY CLERK 0 THE BOARD 2002 American Dental Association All Rights Reserved Reproduction and use of This form by dentists and their staff is permitted.Any other use.duplication or distribution of this form by any Other party require`.Inc prier written approval of the American Dental Association. This Farm is educational orb,.does not constitute legal advice,and covers only federal.not state.law(August 14,2002). &4&fT--/Seb Hello