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* Your organization's name

This agreement is between Vassar Brothers Medical Center’s Office of Continuing Medical Education and the above mentioned organization, a non-accredited provider of continuing medical education (hereafter referred to as NAP).
By its authorized signature on this agreement, the NAP affirms that the CME activities outlined in the application serve to develop, maintain or increase the knowledge, skills and professional performance that a physician uses to provide services for patients, the public, or the profession. The NAP accepts accountability for all aspects in the planning and implementation of these CME activities in compliance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME), and the Medical Society of the State of New York (MSSNY).

VBMC’s office of CME and NAP agree to the following:
1.All proposed CME activities must be reviewed and approved by VBMC’s office of CME to ensure compliance with all Essential Areas and Policies of the ACCME and MSSNY.

2.VBMC’S office of CME as the MSSNY – accredited provider, will assign the appropriate AMA PRA Category 1 Credits™for the jointly provided activity, Further, VBMC’S office of CME will have the authority to withdraw the designation of credit and revoke this agreement at any time during the planning or implementation of the activity if the NAP fails to meet the requirements of ACCME and MSSNY or any other term of this agreement.

3.The NAP will comply with all deadlines pertaining to the completion and transmission to VBMC’s office of CME of all required forms and data pre and post of the CME activity.

4.All commercial support for the activity must be reported to and is subject to the approval of VBMC’s office of CME.

5.All letters of agreement regarding grants and commercial support will be between VBMC’s office of CME and the commercial supporter and will be completed prior to the occurrence of the activity.

6.All monies from approved commercial supporters shall be paid directly to the NAP. The NAP will provide VBMC’s office of CME with a post activity accounting as to how the funds were disbursed upon request.

7.All promotional materials (brochures, advertisements, flyers, syllabi, and handouts) must be approved by VBMC office of CME prior to being printed. This will ensure that required CME language is correct, the commercial supporter is acknowledged and financial disclosure information is properly communicated.

8.The proposed CME activity CANNOT be advertised prior to VBMC’s office of CME’s approval, with the exception of “Save the Date” materials. “Save the Date” Materials can not reference CME Credit in any way prior to the approval of VBMC’s office of CME.

9.A Fee in the amount of $500.00 per application + $100.00 per credit must be made payable 30 days after approval of Joint Providership is received by NAS.

10.NAP agrees to be held responsible for any claims or expenses arising from the NAP’s CME activity.

11.Before applying for Joint Providership, the NAP must be willing to agree and comply with all items listed in VBMC’s office of CME’s Joint Providership policy. (attached)
This agreement is entered into on the below date by Vassar Brothers Medical Center’s office of CME and the aforementioned NAP by the undersigned. This agreement is in effect for the calendar year 2019. Any unused credit at the completion of the aforementioned calendar year, shall be forfeited.

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* Date

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* SIGNATURE: By filling your name here and submitting, you agree to abide by this agreement on behalf of the aforementioned NAP.

ADDENDUM

Title: Joint Providership

Written by: Michelle Palumbo, Manager, CME October 2002


Approved by: CME Committee November 2002


Reviewed: 11/02, 03/04, 11/05, 8/12, 11/13

Revised: 03/04, /05, 8/12, 11/13, 02/14

__________________________________________________________________________________________
Purpose:
VBMC’s Office of CME is accredited by the Medical Society of the State of New York (MSSNY) to provide continuing medical education (CME) programs for physicians. In certifying educational activities, VBMC’s Office of CME is responsible for ensuring compliance with all requirements set forth by MSSNY and the Accreditation Council for Continuing Medical Education (ACCME), including those defining its authority to sponsor programs jointly with non-accredited institutions/organizations.
Educational activities which are consistent with VBMC’s Office of CME’s Mission Statement will be considered for joint providership; and non-accredited entities may seek certification of CME credits (as defined by the American Medical Association) by making application for joint providership in accordance with these policies.

Policy & Procedure:
As joint provider, VBMC’s Office of CME's primary obligation is to MSSNY as its accrediting body and to the ACCME, and it must ensure that the entire jointly provided program is in full compliance with all relevant MSSNY, ACCME, OIG and Vassar Brothers Continuing Medical Education policies, standards and requirements.

For all jointly provided CME activities, VBMC’s Office of CME must be integrally involved from conception to completion with the planning, implementation, evaluation and administration of the activity; and such involvement must be appropriately documented. Vassar Brothers Continuing Medical Education is specifically responsible for ensuring, among other things, that there is adherence to relevant conflict of interest policies that funding arrangements are within acceptable ethical boundaries, and promotional materials, announcements, brochures, and other written publicity include necessary disclosure statements and indicate the appropriate accreditation and credit designation statements.
Recognizing the diverse needs, and capabilities of non-accredited CME providers, VBMC’s Office of CME will consider joint providership if rigorous compliance with the following requirements is demonstrated:

1. Notice of Intent to request joint providership must be submitted at least six (6) months prior to the first date of the program for which joint providership is sought. This notice must describe the applicant's organizational structure, identify the responsible individual(s), and include assurance of VBMC’s Office of CME's integral involvement in all aspects of program development, implementation and evaluation.

2. A signed Joint Providership Agreement.

3. A meeting with VBMC’s office of CME’s coordinators to review all aspects of the joint provider relationship - including detailed discussion of the responsibilities and obligations of all parties and notification of deadlines.

4. A complete Application must be received by the VBMC’s Office of CME at a previously agreed upon time frame before the educational activity. This includes target audience definition, completion of documentation of an adequate educational needs assessment, delineation of specific learning objectives, anticipated attendance and record keeping procedures, and description of proposed teaching methods - as well as full funding, promotion and evaluation plans.

5. VBMC’s Office of CME must approve all promotional materials, syllabi, and handouts - and its role as accredited provider must be acknowledged on all such materials and printed programs.

6. Applicants for joint providership must also agree to provide whatever additional information or materials might be requested by VBMC’s Office of CME Coordinators and/or its Continuing Medical Education Committee in his/her/its review of the applications. Applicants must also comply with all additional policies and procedure established by Vassar Brothers Medical Center’s Office of Continuing Medical Education, and its Continuing Medical Education Committee which relate to and/or govern the conduct of continuing Medical Education Events.

7. Applicants may be asked as a condition of accreditation to present their completed application as well as all planned aspects of said program to the committee in person if deemed necessary by VBMC’s Office of CME’s Coordinators, Chairman and/or Continuing Medical Education Committee.

8. Where joint providership for a CME program is sought from more than one accredited entity, primary responsibility must be assumed by one provider and this fact clearly indicated on promotional materials and printed programs.

Before applying for Joint Providership applicants are required to review the Joint Providership Guidelines. A fee will be charged to entities seeking joint providership in accordance with VBMC’s Office of Continuing Medical Education and Vassar Brother’s Medical Center policies.
PLEASE PRINT A COPY OF THIS AGREEMENT FOR YOUR RECORDS BEFORE SUBMITTING. THANK YOU.
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