HEALTH CARE OUTREACH AND ENROLLMENT
MEMORANDUM OF UNDERSTANDING
This memorandum of understanding between ______, hereinafter referred to as Agency, and the Los Angeles Unified School District’s Children’s Health Access and Medi-Cal Program (CHAMP) is for the purpose of a cooperative healthcare enrollment and outreach activities at specified school sites. It is for use with Agencies that are contractors with Los Angeles County and/or the State Department of Health Services to conduct health care outreach and enrollment and/or have existing Memorandums of Understanding with LAUSD. This agreement is not applicable to any other activities. There will be no cost or fees to either party in connection with this MOU, it is recognized that this agreement will be construed in a manner consistent with the California Education Code, Federal law and other applicable laws and regulations.
Los Angeles Unified School District agrees to:
· Provide a District Liaison for outreach and enrollment;
· Provide Referrals with parental consent;
· Assist with school entry and school articulation;
· Provide CHAMP training on health care programs and school culture;
· CHAMP to provide a sample of approved outreach flyer;
· Hold quarterly meetings to share information and updates;
· Coordinate and hold outreach and enrollment activities inclusive of other participating
District approved Agencies;
· Coordinate outreach and enrollment activities with other District and community resources
to include: Los Angeles County Departments of Health, Public Social Services, school-based
health clinics, and Healthy Starts;
· Collaborate with Agency to identify school sites;
When providing health care outreach and enrollment activities at school sites, the above-mentioned agency agrees to:
· Follow District and local school administrative policies and procedures;
· Coordinate outreach and enrollment activities with local District resources;
· Contact parents referred by CHAMP or school for health care information and enrollment assistance by telephone or mail only, other follow-up services to be made with parental consent;
· Contact referred families within 21 days, or return referrals to the CHAMP liaison with documentation as to why referral is returned;
· Develop School Site Service Delivery Plan with the local District Organization Facilitator and with approval by school administrator;
· Fully inform families of all public and privately sponsored insurance programs (e.g. CHDP, California Kids, Healthy Families, Medi-cal, AIM and KP Cares for Kids), and health care provider options in accordance with the attached State guidelines;
· Screen families for eligibility and enroll children and parents in appropriate insurance programs;
· Charge no fee to LAUSD students or families for service and use no written or verbal solicitation for self-referral, or use information learned about LAUSD students(s) for personal gain or profit;
· Make no referrals to a designated individual, and provide parents with at least three alternative health-care programs (e.g. Healthy Start, school based health clinics, or community resources);
· Provide follow-up services and assist parents with access and retention;
· Maintain student and family confidentiality at all times;
· Avoid any direct contact with students or interruption of classroom learning activities;
· Provide District approved parent presentations on campus;
· Provide CHAMP monthly activity report with feedback on referral outcome and enrollment data, submit through email or hardcopy;
· Inform LAUSD CHAMP liaison of outreach activities;
· Utilize and adapt CHAMP outreach materials for outreach and enrollment;
· Inform CHAMP of service Agency capacity for handling referrals as needed (survey attached);
Conflict Resolution
Should any problems or conflicts arise in the course of the delivery of services, it is understood that the authorized representative of the District will work with the parties in conflict to accomplish an effective resolution through mediation. Inform the CHAMP office of any complaints immediately and cooperate with the District in processing and resolving all complaints whether written or oral.
Insurance
Agency shall present District with an original Certificate of Insurance evidencing insurance coverage for general liability, medical malpractice and workers' compensation. Evidence of insurance covering vehicles will also be required if agency services involve use of vehicle(s) on District site(s). Agency’s general liability and medical malpractice and vehicle coverage shall, at a minimum, provide for limits of $1,000,000/$3,000,000 per claim/occurrence. District shall be named as an additional insured. Provider shall maintain the aforementioned insurance in effect at all times during the life of this agreement. District warrants that it is self-insured with a reserve in excess of $3,000,000.
Liability
Agency shall defend and indemnify District, its officers, agents and employees against all claims, regardless of form, and lawsuits for damages for death or injury to persons or property arising from or connected with services rendered by provider, its officers, agents or employees under this agreement. District shall defend and indemnify provider, its officers, agent and employees against all claims, regardless of form, and lawsuits for damages for death or injury to persons or property arising from or connected with services rendered by District, its officers, agents or employees under this agreement.
Independent Contractor
While engaged in performance of this agreement, Agency is an independent contractor and is not an officer, agent, or employee of the District.
Page 3
This agreement applies only to the schools specified on the attached school site plan and does not allow community agency personnel access to confidential student school records.
This agreement is effective from the date signed by both parties through June 30, 2003 and may be extended by mutual agreement of both parties. Either party may cancel this MOU with a 30 day written notice. Any written notice to the District and the CHAMP office shall be deemed given when deposited in school mail, all charges prepaid, and addressed to the District contact person.
The District contact person for this agreement is:
Beatriz de la Rocha, CHAMP Coordinator
LAUSD CHAMP Program
644 West 17th St. Bldg. A
Los Angeles CA 90015
(213) 763-8304
The Agency contact person for this agreement is:
NAME ______
TITLE______
ADDRESS______
PHONE NUMBER ______email______
In witness hereof, the parties hereto have caused this agreement to be duly executed.
______
Agency Representative Beatriz Garcia-de la Rocha
LAUSD CHAMP Coordinator
______
Date Date
Attachments: Health Care Outreach and Enrollment Assistant Survey
State Guidelines
School Site Service Delivery Plan
Ethics Policy Statement and Non Discrimination Statement
Monthly Reporting Form
C: Local District Superintendent
John Di Cecco, Director Integrated Student Health Partnerships
School Administrator
Organization Facilitator(s)
Page 3