EXHIBIT C

NCCCN Sickle Cell Disease Collaborative

Participant elects to participate in the NCCCN Sickle CellDisease Collaborative (hereinafter referred to as “Program”) as part of this Agreement. Any capitalized terms which appear herein shall have the same meaning as given in the Agreement unless otherwise noted.

Purpose: The purpose of the Program is to develop and sustain a collaboration among NCCCN, one or more of its nonprofit community organizations where private and public health care providers collaborate to provide services (hereinafter “CCNC Networks”), community-based organizations (hereinafter “CBO”) such as Participant, hospitals, specialists and officials from the DHHS Divisions of Medical Assistance and Public Health (hereinafter “DHHS stakeholders”) to improve the quality of care and to reduce the cost of care to adults and children in North Carolina living with sickle cell disease. The result of the collaboration will be continuity between systems of care and co-management of Medicaid beneficiaries who live with sickle cell disease (hereinafter “Mutual Patients”).

Roles and Responsibilities of Participant: In collaboration with NCCCN, CCNC Networks and DHHS stakeholders, Participant agrees to do all of the following with respect to Mutual Patients:

  1. Develop, promote and implement, as applicable:
  2. Best practice in primary care;
  3. Enhance co-management between hospitals, specialists and primary care clinicians;
  4. Build systems for transition from pediatric to adult health care;
  5. Decrease fragmentation of care;
  6. Collaborate with NCCCN’s Chronic Pain Initiative (CPI) to meet the needs of Mutual Patients;
  7. Partner with the Child Health Accountable Care Collaborative of NC (CHACC) partnership to develop a model for coordinated care that will improve the health, quality of care, and costs for Mutual Patient;
  8. Partner with the NC Division of Public Healthin sickle cell related program sponsored by DPH
  9. Ensure that each of its Sickle Cell Educator/Counselor assumes the responsibility for the following on going services:
  10. Consultation with medical providers on behalf of Mutual Patients for whom the Educator/Counselor is assigned (“Clients”);
  11. Provision of sickle cell counseling to such Clients and their families;
  12. Identification of specific Client medical needs including referral to appropriate primary and specialty care providers;
  13. Development and implementation of a Client centered care plan;
  14. Determination of Client financial eligibility for the NC’s “Purchase of Medical Care Program”;
  15. Provision of crises intervention and social support services to the Client; and
  16. Provision of referral services to community agencies, organizations and other local entities as needed to meet the needs of the Client.
  17. Participant will notify NCCCN and applicable Care Manager Program Lead at the applicable CCNC Network(s) with the names and roles of each of its Sickle Cell Educator/Counselor and identify such individuals as its Authorized Users. Participant will ensure that these designated employees participate in training conducted by the Network or NCCCN.
  18. Participant will terminate an Authorized User’s access to Patient Information within 24 hours after the termination of such Authorized User’s employment and immediately notify, in writing, the Network, or NCCCN, as appropriate, that such employee no longer qualifies as an Authorized User. The Network, or NCCCN, as appropriate, will immediately terminate the employee’s access to Patient Information upon notification.
  19. To the extent permitted by law, provide relevant data as requested by NCCCN, DMA or DPH, if applicable, for Program evaluation purposes.
  20. Participant agrees to acquire, access, use and disclose Patient Information solely for the following purposes:
  1. To target its interventions to Mutual Patients; and
  2. To facilitate treatment, care coordination, and quality improvement by accessing anindividual’s visit history, medication list, discharge summaries and other relevant information and sharing that information via secure transmission to appropriate care providers.

NCCCN’s Roles and Responsibilities:In accordance with NCCCN policies and procedures, NCCCN will:

  1. Provide access to a secure site for the purpose of sharing information on performance indicators specific to sickle cell disease.
  2. Provide System support by issuing access credentials (ID/password) and necessary training for the Informatics Center Provider Portal and Report Site to Participant’s Authorized Users if such training and support cannot be provided by Network.
  3. Promote standards that ensure coordinated, comprehensive care for individuals with sickle cell disease with active involvement of Participant, CCNC Networks and DHHS stakeholders.

CCNC Network’s Roles and Responsibilities: In accordance with applicable CCNC Network policies and procedures, participating CCNC Network will collaborate with NCCCN, CBOs, hospitals, specialists and DHHS stakeholders to improve the quality of care and to reduce the cost of care to adults and children in North Carolina living with sickle cell disease and work to achieve the goals and objectives of this Sickle Cell Disease Collaborative. Specifically, the Network will facilitate communication between Network Care Managers and Participant’s Sickle Cell Educators (i.e., Participant’s Authorized Users).