MOA 34-26047 - UNC-CH-Onsite Psychiatry Services - Sourcing Event

MEMORANDUM OF AGREEMENT (MOA)
BETWEEN
NORTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES
DIVISION OF STATE OPERATED HEALTHCARE FACILITIES -
MURDOCH DEVELOPMENTAL CENTER
AND
UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL
SCHOOL OF MEDICINE - DEPARTMENT OF PSYCHIATRY
MOA #34-26047
ONSITE PSYCHIATRIC SERVICES
This Memorandum of Agreement (MOA) is hereby entered into by and between the North Carolina Department of Health
and Human Services (NC DHHS), Division of State Operated Healthcare Facilities (DSOHF), Murdoch Developmental
Center ("Division"), and the University of North Carolina (UNC) at Chapel Hill, School of Medicine's Department of
Psychiatry ("Contractor"). Division and Contractor may be referred to collectively as the "Parties".
The purpose of the agreement is for the Contractor to provide Onsite Psychiatric Services.
1. Agreement Documents: This agreement consists of the following documents, which are incorporated herein
by reference:
a. Agreement introduction/cover
b. Scope of Work
c. ATTACHMENT A: PRICING FORM
d. ATTACHMENT B: NC CONTRACT TERMS AND CONDITIONS - MEDICAL SERVICES
e. ATTACHMENT C: STATE CERTIFICATIONS
f. ATTACHMENT D: FEDERAL CERTIFICATIONS
g. ATTACHMENT E: CONTRACT ADDENDUM FOR VACCINATION AND INFECTION CONTROL
h. ATTACHMENT F: DSOHF VACCINATION POLICY AND ATTESTATION
i. ATTACHMENT G: FRAUD, WASTE AND FINANCIAL ABUSE COMPLIANCE
2. Effective Period: The Agreement shall have an initial term of three (3) years, beginning on January 1, 2027
through December 31, 2029. In addition to any optional terms, and with the Contractor's concurrence, the
Division reserves the right to extend an agreement term for a period of up to 180 days in 90-day-or-less
increments. The terms and conditions of the Agreement shall be reviewed no more frequently than annually to
ensure consistency with fair market value for the services provided and may be amended upon mutual
agreement of the parties.
3. Contractor's Duties: Contractor shall provide the services as described in the scope of work and in accordance
with the approved budget. Contractor shall invoice the Division. The standard format for invoicing shall be Single
Invoices meaning that the Contractor shall provide a monthly invoice within ten (10) calendar days following the
end of each month in which services were performed. At a minimum, the following fields shall be included on
all invoices: Contractor's Billing and Remit to Address, NC Agreement Number, UNC School of Medicine
Agreement Number, Date of services and total amount due.
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Agreement Number: 34-26046 UNC SOM #
4. Division's Duties: The Division shall reimburse the Contractor in the manner and in the amounts specified in the
Agreement. The total amount paid by the Division to the Contractor under the Agreement shall not exceed the
cost outlined in Attachment A: Pricing.
5. Agreement Administrators: All notices permitted or required to be given by one Party to the other and all
questions about the Agreement from one Party to the other shall be addressed and delivered to the other Party's
Agreement Administrator. If any contact information changes, the Party is to let the other Party know
immediately in writing.
For the Division:
MURDOCH DEVELOPMENTAL CENTER
AGREEMENT ADMINISTRATOR
Name: Ruby Royster, Purchasing Director
Address: Murdoch Developmental Center
1600 East C Street
Butner, NC 27509
PH: 919-575-1131
EMAIL: ruby.royster@dhhs.nc.gov
For the Contractor:
UNIVERSITY OF NORTH CAROLINA (UNC)
AGREEMENT ADMINISTRATOR
Name:
Address:
PH:
EMAIL:
6. Agreement Managers: Managers will be responsible for corresponding with each other in order to manage the
deliverables and reject or accept goods and services. The Agreement Managers will be the first point of contact
for any contractual performance concerns or issues. If a resolution is not reached, the Agreement Managers
will notify the Agreement Administrators to provide a formal complaint.
For the Division:
MURDOCH DEVELOPMENTAL CENTER
AGREEMENT MANAGER
Name: Jason Hockaday, Business Manager
Address: Murdoch Developmental Center
1600 East C Street
Butner, NC 27509
PH: 919-575-1102
EMAIL: jason.hockaday@dhhs.nc.gov
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Agreement Number: 34-26046 UNC SOM #
For the Contractor:
UNIVERSITY OF NORTH CAROLINA (UNC)
AGREEMENT MANAGER
Name:
Address:
PH:
EMAIL:
7. Incorporation of Master Agreement: This Agreement is entered into pursuant to, and is governed by, the terms
and conditions of the Master Agreement between the parties (dated 15 May 2023), which are incorporated herein
by reference. In the event of a conflict between this Agreement and the Master Agreement, the terms of this
Agreement shall control solely with respect to the subject matter herein, and the Master Agreement shall
otherwise remain in full force and effect.
8. Signature Warranty: The undersigned represent and warrant that they are authorized to bind their principals to
the terms of this agreement.
In Witness Whereof, the Contractor and the Division have executed this agreement.
CONTRACTOR - University of North Carolina (UNC), School of Medicine - Department of Psychiatry
____________________________________________________________________
Printed Name and Signature
_____________________________________________________________________
Title and Date
DIVISION - NC DHHS, Division of State Operated Healthcare Facilities - Murdoch Developmental Center
Jason Hockaday
___________________________________________________________________
Printed Name and Signature
Business Manager
___________________________________________________________________
Title and Date
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Agreement Number: 34-26046 UNC SOM #
SCOPE OF WORK
BACKGROUND
Murdoch developmental Center (MDC) must provide psychiatric services for any of the 375 (yearly average) men,
women, and children living at MDC who require this service. Federal ICF/IDD regulations, specifically W-322 requires
that the Center, "must assure individuals with mental illness are referred to specialists for proper diagnosis and
treatment." In addition, ICF/IDD Regulation W-312 states that, "for any individual who receives psychotropic
medications, the psychiatric diagnosis must be based on a comprehensive psychiatric evaluation which supports the
psychiatric diagnosis." Psychiatric services must be provided by psychiatrists, as psychiatric consultations and follow-up
are beyond the scope of primary care staff physicians. ICF/IDD regulations require that referral to specialists be available
when necessary; and stipulates that there must be "follow-up to recommendations for referrals to specialists when
appropriate for specific examinations or evaluations and treatments, and those medical services must be provided to the
individual if not provided in-house. There must be a written agreement that specifies the responsibilities of the facility
and outside provider."
A significant number of the men, women, and children who live at MDC have psychiatric diagnosis or behavioral disorder
requiring treatment with psychiatric medication(s). In most individuals these problems are life-long, and for many,
prevent them from living in less structured or community environments. Many of these individuals would be a danger to
themselves or others without continuous supervision and specialized treatment. Without appropriate treatment, these
individuals would not be able to participate in activities of daily living or have any hope of community involvement, such
as special outings and supported employment. By providing on site psychiatric services, MDC is able to provide
individually tailored medication regimens and comprehensive treatment programs to meet the mental health needs of
each individual in a timely fashion. Failure to provide this specialized psychiatric consultation could result in standard
level deficiencies with resulting funding cuts for the provision of services to individuals who live at MDC.
Murdoch's Children's Outpatient Assessment Clinic provides a thorough review and assessment of the complex clinical
needs of the children referred. Initially these referrals came from within the North Central Region but as of January
2018, it now accepts referrals from the entire state of North Carolina. The Children's Assessment Clinic is a coordinated
effort between Murdoch's Professional Services and Health Services departments. The end result of the clinic visit will
be the development of a Comprehensive Clinical Assessment that will outline the types of services and supports the
person is likely to need in order to obtain/maintain optimal functioning within the home, school, and community
environment. Assessment teams will always include a psychiatrist, as well as a physician, psychologist, and social
worker, as well as a medication review by a pharmacist. Involved clinicians will be making recommendations based on
review of assessment results and historical information/records, observations of and interactions with the child in the
clinic setting, and information obtained from family, care providers, and care coordinators.
PROJECT OBJECTIVES
Division will procure the services of Contractor's licensed Psychiatrist(s) to evaluate and make recommendations for
appropriate and medically sound mental health psychiatric treatment including the use of psychotropic medications as
indicated. A contractual agreement for Psychiatry with the UNC-CH Department of Psychiatry will ensure that ICF/IDD
regulations are met for this specialty medical service, as well as meeting the Center's goal to provide adequate mental
health care to the individuals served. In addition, psychiatry involvement in the outpatient assessment clinic is essential
for the provision of comprehensive, collaborative, clinical recommendations that will help children with complex needs
maintain community placement.
PROJECT METHODS OR DESIGNS
Licensed physicians who are specialists in the field of Psychiatry ("Psychiatrist") shall provide Child and Adolescent
Outpatient Psychiatric services (the "Services") through a contractual agreement with Division up to a maximum average
of 35 hours per week.
The Psychiatrist(s) will:
* Review pertinent information about each assigned individual, including past medical and psychiatric history;
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* Attend and participate in the Neuropsychiatric Behavioral Review (NBR) meetings, which includes evaluation,
data analysis, team discussion, and documentation, on at least a quarterly basis for 100% of assigned
individuals;
* Evaluate individuals and attend NBR meetings on an urgent or emergent basis if the individual's condition
warrants;
* Evaluate the individual and make treatment recommendations based on a full analysis of the available
information;
* Ensure the comprehensive NBR note is created on each individual reviewed, following the established Division
format, prior to leaving the facility on each workday;
* Contribute to the comprehensive clinical assessment process developed within the Needs Assessment Clinic
(i.e. reviewing historical information, meet with the child and family, collaborate with the team to develop pertinent
diagnosis and treatment/support recommendations).
Division will (at no cost to the Contractor):
* Schedule the individuals to be evaluated or reviewed by the Psychiatrist;
* Provide the Psychiatrist a list of scheduled appointments and any changes on each scheduled workday;
* Provide a file of relevant psychiatric history for each assigned individual, upon arrival on each scheduled
workday;
* Assure that each created note is formatted for charting and submitted to the Psychiatrist for final review, and
then route for filing in medical record;
* Provide an office space for the Psychiatrist(s) and necessary resources for the documentation of clinical
findings and treatment recommendations;
* Provide referral packet information as soon as possible for all upcoming clinic referrals.
PROJECT EVALUATION
The Division's attending physician or physician extender will be present at the NBR meetings and will have clinical
oversight. If a treatment recommendation does not meet the current ICF/IDD regulations or current standards of care,
the Division attending physician, physician extender or other professional team members will discuss with the
Psychiatrist and the treatment will not be prescribed.
The Health Services office staff will track completion of all assigned psychiatric evaluations, NBR meeting attendance,
and created notes/charting on assigned individuals. The MDC Director of Health Services will be notified of any missed
sessions or incomplete documentation and will discuss any concerns with the UNC contract psychiatrists, or the chair of
the UNC-CH Department of Psychiatry as deemed necessary.
The psychiatrist shall ensure a comprehensive NBR note is completed for 100% of the individuals reviewed prior to
leaving the facility each workday, following the Division's established format.
A random sampling of 20% of NBR cases will be reviewed by the Treatment Review Committee and/or Health Services
to determine that the established format is followed, documentation is complete and ICF/IDD regulations are followed.
Any inappropriate medical treatment or unethical conduct would jeopardize the continuation of the contract
relationship. Any breach of adherence to accepted standards of medical care or unethical conduct will result in
notification of proper governing bodies (i.e, NC Medical Board, MDC Advocacy Department, MDC Human Rights
Committee, and MDC Administration).
The Director of Professional Services will provide requested information regarding the Needs Assessment Clinic to
DSOHF for tracking purposes.
REIMBURSEMENT
$328,692.00 is required to fund the services of up to three (3) part time psychiatrists, for SFY 2026, to provide psychiatric
services to the individuals who live at MDC. The current rate for SFY 2026 is $168.00 per hour to provide consultation
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and supervision over the use of psychotropic medications. The maximum hours per week shall not exceed 35 hours for
the up to three (3) psychiatrists. A 7.5% Administrative Fee will be added each year with a maximum annual contract
value of $328,692.00 and a cumulative three (3) year contract value of $986,076.00.
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Agreement Number: 34-26046 UNC SOM #
CONTRACT EVALUATION CRITERIA
APPENDIX I
I. Competencies
Meets Does Not Meet
Expectations Expectations
Patient Care
Medical Knowledge
Practice based learning and improvement
Interpersonal and communication Skills
Professionalism
System-based practice
Explanation/Definition of Evaluation Criteria
Patient Care is compassionate, appropriate, and effective for the treatment of health problems and promotion of health.
Medical Knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-
behavioral) sciences and the application of this knowledge to patient care.
Practice-based learning and improvement that involves investigation and evaluation of their own patient care,
appraisal and assimilation of scientific evidence, and improvements in patient care.
Interpersonal and communication skills that result in effective information exchange and teaming with patients, their
families, and other health professionals.
Professionalism, as manifested through a commitment to carrying out professional responsibilities, adherence to
ethical principles, and sensitivity to diverse patient populations.
Systems-based practice, as manifested by actions that demonstrate an awareness of and responsiveness to the larger
context and system of healthcare and the ability to effectively call on system resources to provide care that is of optimal
value.
II. Criteria used to evaluate Practitioner:
A. General Practice Review
Quality Practice Review Actual Result___________________

Comparative Result_______________
Treatment Plan Review Actual Result___________________

Comparative Result_______________
High Risk Practice Review Actual Result___________________

Comparative Result_______________
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Restrictive Intervention Review Actual Result___________________
Comparative Result_______________
B. Medication Quality Practice Review
Medication Variances Actual Result___________________

Comparative Result______________
Multiple Antipsychotics Actual Result___________________

Comparative Result______________
Forced Medication Review Actual Result___________________

Comparative Result_______________

C. Medical Records Deficiencies Actual Result__________________
Comparative Result______________
D. Diagnostic & Treatment Conference Attendance Actual Result__________________

Comparative Result______________
E. Resident Physician Evaluation Result________________________

Comparative Result______________
F. Patient Satisfaction Survey Result________________________

Comparative Result__0-5____________
G. CME Credits Reported Result________________________

H. Adverse/Sentinel Events Result________________________


I. Patient/Staff Feedback/Complaints Result________________________

J. Peer Review of Diagnostic & Treatment Conf. Result________________________

K. Peer Review of Didactic Presentation Result_________________________

L. Med Psych Committee Attendance Actual Result____NA______________
(not applicable secondary to ongoing clinical scheduling conflict)
III. Overall Assessment of Professional Performance (use additional pages as necessary):
Based on review, this practitioner's professional practice
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meets expectations in all areas

does not meet expectations in all areas; PMP Developmental Plan initiated.

exceeds thresholds for practice expectations - Recommendations:
______________________________
Signature Date
______________________________
Printed/Title
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Agreement Number: 34-26046 UNC SOM #
APPENDIX II
Resident Evaluation of Attending or Supervisor
CONFIDENTIAL
Learner Feedback on Teaching Effectiveness: Our faculty members rely on your frank evaluation and feedback
about their teaching or supervision in order continually to monitor and improve their teaching skills. Your appraisal of
the items listed below will help this process. Your response is strictly anonymous.
Thank you for your assistance.
Faculty Name: Date of Rotation: ____
Where have you received training or supervision from this faculty member? Please mark (X) all that apply:
On Call Psychotherapy Group Psychotherapy
Inpatient Wards Medical Specialty Clinic Case Conference
Outpatient Clinic C/L Service Formal Lecture
Screening Clinic Off-Site Clinic Seminar
Other Situation (specify)
Using the following scale, please evaluate:
No opinion/ Poor Good Outstanding
Don't know 1 2 3 4 5
Content [ ] [ ] [ ] [ ] [ ] [ ]
(e.g., relevant, useful, practical, fits my needs)
Teaching Style [ ] [ ] [ ] [ ] [ ] [ ]
(e.g., engaging, motivating, effective, understandable,
constructive feedback)
Professional Role Model [ ] [ ] [ ] [ ] [ ] [ ]
(e.g., attitude, behavior, leadership, approachability)
Overall Effectiveness [ ] [ ] [ ] [ ] [ ] [ ]
Comments, including suggestions for improvement:
(Use back side of form if more space is needed.)
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