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W I To_NDrma1'LCarlSon.,_Chairman Date October 38,_1984___
Board of Commissioners
COLORADO From Walter J. Sperkman, Fxeretive Director, Human Resour
Subject: Head Start Dental Agreement with Sunrise Cemmunity___tlealth_ren.ter_.
Enclosed for Board approval is an agreement between Head Start and the
Sunrise Community Health Center. The agreement provides for dental services
to be provided by the health center for Head Start children.
Head Start will reimburse the Sunrise at the rate of $5.00 for every dental
examination performed. Any additional dental work that needs to be performed
(beyond an examination) , will be billed to Head Start the the prescribed rate
based on a sliding scale. Head Start is not responsible for payment for any
child who is covered by Medicaid.
In the past, Head Start has utilized various private dentists to provide the
required dental services. It is anticipated that this agreement could result
in as much as a 50% savings for dental services when compared to previous
years.
The term of this agreement is from November 5, 1984, through May 17, 1985.
If you have any questions regarding the attached agreement, please do not
hesitate to contact me immediately.
6 4D 91 f,
171 I
AGREEMENT
THIS AGREEMENT, made and entered into the 5th day of November, 1984
by and between the Sunrise Community Health Center, hereinafter referred
to as "Health Center" and the Weld County Division of Human Resources '
Head Start Program, hereinafter referred to as "Head Start".
WITNESSETH
That for and in consideration of the covenants and agreements
herein agreed to be kept and performed, the Health Center hereby agrees
to provide to Head Start the following described services upon the
following terms and conditions:
1. The Health Center shall provide a dental examination on each
referred Head Start child.
2. Head Start agrees to reimburse the Health Center a maximum
cost of $5.00 per child for dental examination services.
3. The Health Center agrees to provide prophylaxis therapy,
application of topical flouride, x-rays, restoration and/or
extractions as is deemed necessary on each referred Head Start
child. The cost for these services will not be included in
the examination cost.
4. Head Start agrees to reimburse the Health Center for all
dental services (excluding dental laboratory services)
performed beyond a dental examination, at the prescribed rate
based on a zero (0) percent scale. The zero percent scale
does not apply to any dental laboratory work which may have to
be performed.
5. All dental laboratory work must be approved by the Head Start
Director, in writing, before any dental laboratory work may be
performed. All dental laboratory work will be reimbursed
according to the fee scales of the Health Center. Payment for
all dental laboratory work will be the responsibility of the
Head Start Parent and/or Medicaid. Head Start is not
responsible for the payment of any dental laboratory services.
6. Head Start shall not be charged for any Head Start child who
is covered by Medicaid. Medicaid numbers shall be provided to
the Health Center at the time of the set appointment and
billing shall be sent to the appropriate agency by the Health
Center.
7. Head Start agrees to transport Head Start children to the
Health Center to meet scheduled appointments at the Health
Center.
8. The Term of this agreement is from November 5, 1984, through
May 17, 1985.
9. This agreement may be amended at any time with the written
mutual consent of both parties.
10. The Health Center and Head Start mutually agree to accept that
this agreement may be cancelled by either party after a thirty
(30) day written notice has been given to the other party.
IN WITNESS WHEREOF, the parties hereunto have cause this Agreement to be
duly executed as of the day and year first hereinabove set forth.
SUNRISE COMMUNITY HEALTH CENTER WELD COUNTY BOARD OF COMMISSIONERS
Norman Carlson, Chairman
WELD COUNTY DIVISION OF HUMAN
ATTEST/'1LLu.� L�:w,�.' .;uL44.42tr✓ RESOURCES
WELD i.-' ��LR o
BY: ,S Walter J Speckman,
Execut"' e Director
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