H-1 Agr Welfare Services DAVID S. KNUDS~DN
I~.DUNTYATTDRNEY DF SALINE r. DUNTY
300 WEST ASH ' CITY-COUNTY BUILDING
SALINA, KANSAS 6'7401
1-15-73
CONTRACT FOR SERVICES
THIS CONTRACT FOR SERVICES made this day of 1973, and between
the State Department of Social Welfare of Kansas, hereinafter referred to as the
State Department, and
hereinafter referred to as the local health unit
WITNESSETH: THAT, WHEREAS, the State Department is now operating its Medical
Assistance program for assistance recipients and for the medically needy under
Title XIX of the Social Security Act; and
WHEREAS, it is necessary, to implement a medical program of early and periodic
screening, diagnosis and treatment of children under 21 years of age and
WHEREAS,
the local health unit has been certified by .the Kansas State Department of Health
as having personnel that is adequately trained to make the periodic screening
required under this program for all children under 21 who are eligible under Title
NOW, THEREFORE, IT IS AGB~ by and between the contracting parties that
trained personnel of the locat~ health unit will provide the followi~ng services of
periodic screening:
1. Send appointments for screening to the children whose forms have been
received from the welfare departments.
2. Obtain a brief medical and developmental history from parent or other
responsible adult who is familiar with the child's health history, and
attach a copy to the DSW-MSD-121 which will be the county welfare de-
partment' s copy.
3. Complete the screening and the DSW-MSD-121 screening findings.
4. If a child needs a diagnostic referral for abnormal screer~dng findings,
the local health unit will make the referral.
Referrals would be made to the child's own practitioner if he has one or
the child's parent or responsible adult would be asked to select one.
The local health unit would inform the practitioner of the screening
abnormality and request a reply from the practitioner.
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5. For the child and parent (or respo4sible adult) who needs this help,
arrange for the appointment and give an appointment slip to the child
and parent giving the practitioner's name, address, date and time of
the appointment. This could be a volunteer activity pla~med jointly
by the local health unit and county welfare department. If a child
and parent indicate need for other help the county welfare department
should be requested to follow up on the specific need.
6. The local health unit will forward two copies of the DSW-.MSD-121 to
the county welfare department when screening is completed, and the
necessary referrals and appointments are made.
7. Follow up diagnostic information received on each child ~ the local
health unit will be forwarded on a third copy of the DSM--MSD-121 to
the county welfare department or if information is delayed beyond
submittal of the Dsw-MSD-121 reported separately when it becomes
available.
8. The local health unit and the State Department will arrar~e for neces-
sary reports of services provided to recipients of medics.1 assistance
under Title XIX included in this program.
9. Liaison would be maintained at the local level between the local health
unit and the county welfare agency with each agency designating the
liaison person. Each local agency would maintain liaisor.~ with its
state agency through appropriate channels. The two state, agencies
would maintain liaison between the Medical Services Division of the
State Department and the Local Health Services Division of the Kansas
State Health Department and their respective directors.
The local county health unit will bill the County Department for these ser-
vices, using claim forms provided by the State Department identifying each child
by ~me, child' s identification number issued by the State Department, date of
screening, service code (if or when assigned), charge, and submit to the county
welfare department with original copy of MSD-121 per child attached.
It is agreed that the State Department will reimburse the county health
unit at the rate of $ . per child for each examination on an interim
basis, which charge will be adjusted when later cost analysis develops
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the actual costs incurred for these services by the county. The services of
screening by intervieMing and testing Mill be rendered by the local health unit
at periods to be determined by the State Department. Mhen such costs are
deteEained the local health unit Mill repay the State Department for any payment
received in excess of costs deter~ined. Similarly the State Department Mill
pay the local health unit such costs as are determined to be in excess of those
which the State Department has already paid to the local health unit.
IT IS FURT~E~ AGREED A~D UNDE~ST00D between the parties that this agreement
shall be in force for a period of one (1) year beginning Mith the 1st day of
1772, and continuing until terminated by either party upon. sixty (60) days
~itten notice to the other.
IN MITNESS ~REOF, the parties hereto have hereunto set their hands the
day and year in this agreement first above ~itten.
STATE DEPARTMENT OF SOCIAL WELFARE
OF KANSAS
State Director
RESOLUTION NO.
The Board of County Commissioners of Saline County, Kansas,
has been requested to approve a CONTRACT FOR SERVICES by the
Salina-Saline County Joint Board of Health. This contract by amd
between the State Department of Social Welfare of Kansas and the
Salina-Saline County Joint Board of Health.
WHEREAS, the Board 'of County Commissioners of Saline
County, Kansas, has been requested to approve a Contract for
Service between the State Department of Social Welfare of
Kansas and The Salina-Saline County Joint Board of Health, and
WHEREAS, the State Department is now operating its
Medical Assistance program for assistance recipients and for the
medically needy under Title XIX of the Social Security Act; and
WHEREAS, it is necessary, to implement a medical
prog~ram of early and periodic screening, diagnosis and treatment
of children under 21 years of age, and
WHEREAS, THE LOCAL HEALTH UNIT HAS BEEN CERTIFIED
by the Kansas State Department of Health as having personnel
that is adequately trained to make the periodic screening
required under this program for all children under 21 who
are eligible under Title XIX; and
WHEREAS, The Board of Health believes such a Contract
For Services is to the best interest of the people of Salina
and Saline County,
NOW THEREFORE, BE IT RESOLVED BY THE BOARD OF
COMMISSIONERS OF SALINE COUNTY, KANSAS that the CONTRACT FOR
SERVICES made and entered into by the Salina-Saline County Joint
Board of Health and the State Department of Social Welfare
of Kansas is hereby approved and a copy of the Contract is
hereto attached.
Adopted by the Board of Counj~ Commission~rs, of
Saline County, Kansas, this o~~ day of ~_~. 1973.
SALINE COUNTY BOARD
OF COMMISSIONERS
SALINE COUNTY, KANSAS
ATTSjT: ~ 9
~line County Clerk
R. L. Armstrong
La~uren V. Gray ~i man
wayneyckard ~' ' Member
James t. Martin Member