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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. -2- 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 -3- 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