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intilege CantracvGrant Agreement Chocslist, ‘hs fe oud We evil hon ne arco gt cereus ts Preside C's sgt. The far shouldbe Compstel ms the pega ance anys lover Be esa ce a re hy Dies ets Syma tet CPC a pe, on lar Pao izaCEO spt Pew: 857 Cove sect corel by Sue Grd Cova tse Cannes ta. Reet 1 SDETS Aence Pro Orig Ret: Sue Gonna Legon sesh io eve Lt Now Renewal Agree i Licino of Caran agree ZOE abe 90009 Fine Srey Typrortiamertinn Agora, holy Rte Onl, 2erery- wav Fo Meni Rate amt Res a ota te arama lie al Pani Poti Ric ot Orn righting Supervisor Se Psa Disc aner ivan Diseor Spe eof inane Date CaseeGan opremene sigatby ce0:_§/e/ry ore cae 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