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Attachment 1A: Data Licensing Statement <br />1. Background <br />The state of Washington, acting by and through the Health Care Authority (HCA), issued a <br />Request for Application (RFA) dated December 29,2021, (Exhibit A) for the purpose of developing <br />and implementing or continuing to expand Medication for Opioid Use Disorder (MOUD) in Jails <br />Program in accordance with its authority under chapters 39.26 and 41.05 RCW. The resulting <br />Statement of Work requires the jail to share specific Data with HCA regarding individuals with <br />Opioid Use Disorder <br />2. Justification and Authority for Data Sharing <br />The Data to be shared under this DSA are necessary to comply with 2021 Engrossed Senate Bill <br />5476 and Engrossed Substitute Bill 5092 directing HCA to implement and enhance medication for <br />Opioid Use Disorder in jail programs. <br />3. Purpose / Use I Description of Data <br />The purpose of this DSA is to provide terms and conditions under which HCA will allow the restricted <br />use of its Data to the Contractor, and under which the Contractor may receive and use the Data. This <br />DSA ensures that HCA Data is provided, protected, and used only for purposes authorized by state <br />and federal law governing such Data use. <br />The scope of this DSA only provides the Contractor with access and Permissible Use of Data; it does <br />not establish an agency relationship or independent contractor relationship between HCA and the <br />Contractor. <br />a. File Layout: The Parties will exchange Data using the mutually agreed upon file layouts below <br />The Parties may edit and/or change the Fle Layout as considered necessary. <br />Method of Access/Transfer: Once an established Secure Data Transfer connection with <br />the host computer at Contractor's location is confirmed, Contractor will provide Data <br />listed in File Layout list below, to HCA. <br />ii. Delivery Method: Secure File Transfer <br />iii. Frequency of Data Delivery: Contractor will transmit Data monthly, by the 1Oth day of <br />the month for the previous month. <br />iv. Costs: NIA <br />Contractor will be sharing with HCA the following Data elements: <br />i. Full name <br />ii. Date of birth <br />iii. Provider One #, SSN or another unique identifier <br />iv. Date of booking <br />v. Date MOUD started: continued or induction? <br />Washington State <br />Health Care Aulhority Page 15 HCA Contract No. K5885-1