MOU Village Family Service Center

0.15 MB·English

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5 Pagel

ECONOMIC ASSISTANCE
Memorandum of Agreement

‘This Agreemert is entered batwaen the Village Famlly Services Canter {Agoncy
Providen, The Vilage Family Servise Genter and the North Dakota Deparknert of
Hyman Services (NDDHS).

NDDHS is responsible for supervision of the Alternatives to Abortion Program. The
Village Family Service Centor wit administer fre Alternatives to Abortion Program
including marketing, updating and raincaining a lst of service praviders, making
payments lo service providers aid 1-800 service.

‘Tae program will provide positive cutcomeshased Infarmation, counseling, and support
services with the following requirements and expectations:

+L. Provide sarvices to pregnant wamer oF worien who beliave they may be
pregnant, who reside in Nerch Dakota.

2. Promote childbirth through information, counseling ané education fo assist
pregnant women to choosa childbirth,

3, Assist wemen in making Informed decisions about adoption or parerting wilt
ragpoct to the chil

‘Alternatives lo Abortion services do nol inewude medicat services,
“The Agency Provider desires ta provide Altematives to Abortion services consistent with

the requirements of the Alteraatives to Abortions Program and 1 ines! tha requirements
Of NDC. § 90-06-26 and this Agreement, The Agency Provider agrens to:

1. Seren each potential client fo astablish that sha is pregnant or reasonably
beleves sha may be pragnant;

2, Inform each cliant that it ig har ght to seoura Alternatives Iv Abortions se-vices
from a provider of thao services listed ir the Allernativas ta Abortions brachure

43, Assis| NDDHS and The Village Family Service Center in gattering data to
evaluate the Ateratives to Abortions Program frozr: the client's first visit through
bth of the child;

4, Keep confidentiai the commureations between a child ard provider arts
‘employees and agents, except as pormilled by law or by the mformes agreament
of the cant;

6. Submit to NDDHS ane! The Vilage Family Se-vice Center a copy of provider's
liability insurance Galicy for approval before requesting payment; and

6. Maintain approved llaalty coverage in etfec at all mes services are beng
provided under this Agreement,
Agency Provider agrens not to

4. Counsel for, refer for, encourage, of perfor abortions, or kaewlagly ‘afer an
‘Alternatives te Abortions client io anther person or agency for the purpose of
seeiving counseiing for, refertal for, encouragertant for, or the performance of
an abertion| or

2. Discriminate agairst Akematives to Ahostions cliont on the basis of refglon, a
religious belief @ refusal fo hold a religious belie, or 2 refusal to actvely
pparticinate in a religious practice.

Provider for Alternatives to Abortions services will receive reimbursernert for services
provided based om a rata of $12.00 for each quarter hour of service fumished by
ember of the clergy, a nurse licensed under N.D.C.C. ch. 43-12.1, a physician
licensed undet N.0.C.6. ch, 49-17, a psychologist licensed under N.0.C.C. oh. 43-32, a
social worker licensed under N.D.G., ch. 43-41, an addiction counselor licensed under
N.D.C.C. ch. £3445, a counselor eensed under N-D.C.C. ch, 43.47, ora mavriage and
family terapist licensed ander N.D.C.C. eh, 43-83; and at a rate of $5.00 for each
quarter hour of service furnished by any other indkadual

“This Agreement i affective July 2017 and emelas in effect unt! June 90, 2019. unless
eiminated by the Agenoy Provider, The Vilage Family Service Center or NDDHS.

“This Ageement may be terminated at any {ime by rmutual consent of partes, ar upon
830-days' written notice by eltrer party, with or without cause. Fallure by the Age roy

Provider to pertormn the terms of this Agreemenl may result the immediate termination
af the Agrecmont.

Agency Pro r Sentce Contes
Signet Date
ie — ee

‘Tha Vilage Family Service Center

‘cia vate:_ £4)

Doug Vang Presidenv/EO
“The Vilage Family Servic Genter

€; Caral Cerlledge, Director
Economic Assistance Policy Division
Nort Dakots Deparment of Human Services