HomeMy WebLinkAboutWSALPHO (2)WASHINGTON STATE ASSOCIATION OF LOCAL PUBLIC HEALTH OFFICIALS -
KITTITAS COUNTY PUBLIC HEAL TH DEPARTMENT
AGREEMENT
This AGREEMENT formalizes the understanding between the Washington State Association of
Local Public Health Officials (WSALPHO) and Local Health Jurisdiction (LHJ) Kittitas County
Public Health Department (KCPHD) regarding the operation of Medicaid Administrative
Claiming (MAC) in Washington State.
ARTICLE I
PURPOSE
The purpose of this AGREEMENT is to facilitate the operation of a statewide Random Moment
Time Survey (RMTS) that complies with the requirements of the LHJs' Cost Allocation Plan
approved by the Centers for Medicare and Medicaid Services (CMS), and the MAC contract
between HCA and each participating LHJ. The Agreement will also assist in oversight activities
of the Health Care Authority (HCA) working with the LHJ MAC Steering Committee to provide
coordination and program compliance among participating LHJ s.
ARTICLE II
DEFINITIONS
A uth 01ized Representative: The person or persons authorized by the LHJ and WSALPHO to
coordinate activities under this AGREEMENT (the MAC Coordinator) will be the Point of
Contact for response to monitoring activities. Contact information for the LHJ and WSALPHO
Representative, or the person who will connect the caller to the Authorized Representative, is
found in Article III of this AGREEMENT.
Business Associate: As defined in 45 CFR, Part 160.103 , otherwise known as HIP AA, and
includes any entity that performs or assists in performing a function or activity involving the
uses/disclosures of individually identifiable Health Information or involving any other function
or activity regulated by HIP AA; or provides legal, accounting, actuarial, consulting, data
aggregation, management, accreditation, or financial service where the services involve
individually identifiable Health Information.
B usiness D ays and Ho urs : Shall mean Monday through Friday, 8:00 a.m. to 5:00 p.m., Pacific
Time, except for holidays observed by the State of Washington.
Centers for Medicare and Medicaid Secyices (CMS ): A federal agency within the Department of
Health and Human Services responsible for the administration and oversight of the Title XIX
Medicaid Administrative Claiming program.
Consortiu m: LHJs are grouped into consortia based on similar duties staff perform,
organizational structure, types of programs, scope of work, or regional working relationships and
participate in a common Random Moment Time Survey (RMTS) together in order to achieve the
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level of statistical validity in the RMTS required by CMS. Each consortium composed of more
than one LHJ will identify a member LHJ to act as the Lead Agency for the consortium and
serve on the statewide LHJ Steering Committee. Each LHJ that is the sole entity in a
consortium, such as Public Health -Seattle & King County, will identify a single person to
represent it on the Steering Committee.
Cost Allocation Plan: A federally-approved plan describing the methodology and procedures for
claiming federal reimbursement for activities that are necessary for the efficient administration of
the State Medicaid Plan.
Health Care Authority (HCA): The State agency responsible for administration and oversight of
the Medicaid Administrative Claiming program in Washington State.
HIP AA Rules: "HIP AA Rules" shall mean the Privacy, Security, Breach Notification, and
Enforcement Rules at 45 CFR Part 160 and 164.
Lo cal Health Jurisdiction (LHJ): A signatory health department, health district, or county within
the State of Washington that operates a public health department or division within its county
government pursuant to authority granted under Chapters 70.05, 70.08, 70.46 RCW or other
applicable law.
LHJ MAC Contract: The legal agreement between HCA and the LHJ for participation in the
MAC program. The contract lays out the responsibilities of each party for ensuring program
compliance.
LHJ MAC Steering Committee: The LHJ MAC Steering Committee (Steering Committee)
functions as an advisory board working under the direction ofWSALPHO leadership. The
Steering Committee provides broad oversight of the LHJ MAC program in Washington State and
acts as a point of contact for HCA staff.
Medicaid Administrative Claiming (MAC): Title XIX of the Social Security Act (the Act)
authorizes payments to states for expenditures necessary for the administration of the State
Medicaid Plan.
Proportional h are : The percentage paid by each LHJ to WSALPHO for the costs of the
WSALPHO Contractor and WSALPHO 's administrative fee is based on the proportional share
of the total federal reimbursement paid to all LHJs for MAC activities for the most recent four
quarters for which there is complete data.
Protected Health Information: Shall have the same meaning as those terms in the HIP AA Rules.
R a ndom Momen t Time Stu dy : A web-based system operated by WSALPHO's Contractor that
captures the activities that can be reimbursed under Medicaid Administrative Claiming via a
CMS-approved time survey methodology.
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Washington State Association of Local Public Health Officials: WSALPHO is a 501(c)3 private,
non-profit organization operating on behalf of Local Health Jurisdictions to advance the interests
of local public health in Washington State.
WS ALPHO C ontractor: Vendor contracted through WSALPHO to operate an RMTS and
claiming system [including offset, indirect rate, and Medicaid Eligibility Rate (MER)for the
MAC program that is compliant with the currently approved LHJ Cost Allocation Plan and to
provide consultation and technical assistance to the Steering Committee and LHJs , as directed by
the Steering Committee.
ARTICLE III
AUTHORIZED REPRESENTATIVES
Kittitas County Public Health Department
Tristen Lamb
Administrator
507 N Nanum Street, Suite 102
Ellensburg, WA 98926
ARTICLE IV
WSALPHO
Jaime Bodden
Managing Dir ector
206 l 0th Street
Olympia, WA 98501
RESPONSIBILITIES OF LOCAL HEAL TH JURISDICTIONS
Local Health Jurisdictions participating in the Medicaid Administrative Claiming program will:
• Participate in the MAC claiming program through an inter-local AGREEMENT between the
LHJ and HCA, and participate in an RMTS operated by the WSALPHO Contractor.
• Participate in peer review or other quality assurance activities to ensure the program 's
compliance with all federal regulations and federal and state published guidance.
• Name an employee to act as the MAC Coordinator who will oversee MAC activities at the
LHJ and monitor their compliance with federal and state regulations and published guidance,
including the RMTS and the development and updating of all non-fiscal documents required
for the MAC audit file .
• Name an employee to act as the MAC fiscal coordinator, who will oversee the development
of the quarterly MAC invoice, certify its accuracy, and maintain the fiscal sections of the
MAC audit file .
• The LHJ MAC Coordinator or designee will attend WSALPHO-sponsored trainings as
scheduled .
• The LHJ fiscal coordinator will attend WSALPHO-sponsored fiscal trainings as scheduled.
• The LHJ MAC coordinator will participate in regularly-scheduled Coordinator conference
calls convened by WSALPHO.
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WSALPHO will:
ARTICLE V
RESPONSIBILITIES OF WSALPHO
• Procure a contractor to operate an RMTS and claiming system that complies with the most
current federally-approved Cost Allocation Plan.
• Provide assurance that this AGREEMENT, once executed by the parties, is and remains a
Public Record subject to the provision of Ch. 42.56 RCW, the Public Records Act.
• In conjunction with LHJ Steering Committee, will provide coordination and leadership of the
LHJ MAC program in Washington State to ensure quality assurance and consistency state-
wide.
ARTICLE VI
RESPONSIBILITIES OF MAC CONTRACTOR
The MAC Contractor will operate a MAC RMTS and claiming system for participating LHJ s in
Washington State in accordance with a federally-approved cost allocation plan. The MAC
contractor will also provide consultation and technical assistance, as directed by the Steering
Committee.
The MAC Contractor will submit a proposed work plan that includes proposed tasks, staffing,
timeline, and associated costs to WSALPHO no later than November 15 of the preceding year
for review and approval by WSALPHO and the LHJ MAC Steering Committee, which will be
incorporated annually as an amendment to this AGREEMENT.
ARTICLE VII
INVOICE AND PAYMENT
The Contractor submits a quarterly invoice of actual costs to WSALPHO no later than 60 days
following the end of a calendar quarter to the designee of the LHJ Steering Committee who will
review calculations and approve proposed work for payment. Following approval for payment,
WSALPHO will invoice Public Health Seattle King County and Tacoma Pierce County Health
Department quarterly with the remaining participating LHJs invoiced their proportional share
semi-annually in January and August (for the prior six months), The invoice will link billed
tasks to the annual work plan. The budgeted annual costs for Contractor's services,
WSALPHO's administrative fee, and the LHJ's proportionate share are incorporated by
reference as Contractor Costs and LHJ Proportional Share for calendar year 2019 (Attachment
A).
WSALPHO receives a five percent fee based on the Contractor's budget to administer the MAC
program and coordinate the work of the LHJ MAC Steering Committee. WSALPHO will
reconcile this fee to the Contractor's actual cost and credit each LHJ its proportional share of any
overpayment. This adjustment will be applied to the LHJ' s succeeding year invoice.
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ARTICLE VIII
HIPAA -PROTECTED HEALTH INFORMATION
WSALPHO acknowledges that that the work under this AGREEMENT may require compliance
with "The Health Insurance Portability and Accountability Act of 1996" commonly known as
HIP AA. WSALPHO shall not use protected health information in any manner that would
constitute a violation of HIP AA and any regulations enacted pursuant to its provisions and
Washington State privacy laws and further agrees not to use or disclose Protected Health
Information other than as permitted or required by the AGREEMENT or as required by law.
Contractor agrees to implement physical, electronic, and managerial safeguards to prevent
unauthorized access to Protected Health Information.
WSALPHO Contractors that may use the LHJ Protected Health Information in the course of their
work are considered to be a Business Associate ofWSALPHO and the LHJ.
The LHJ reserves the right to monitor, audit, or investigate the use of Protected Health
Information collected, used, or acquired by Contractor through this AGREEMENT.
The obligations set forth in this Section shall survive completion, cancellation, expiration, or
termination of this AGREEMENT.
ARTICLE IX
INDEMNIFICATION
Each party shall indemnify, defend and hold harmless, each other, its officers, agents and
employees, from and against any and all claims, lawsuits, demands for money damages, losses or
liability, or any portion thereof, including attorney's fees and costs, arising from the negligent
acts or omissions of the parties, its employees, or representatives.
ARTICLEX
RIGHTS IN DATA
Records and other documents in any medium, furnished by one party to this AGREEMENT to
the other party, will remain the property of the furnishing party, unless otherwise agreed. The
receiving party will not disclose or make available this material to any third parties without first
giving notice to the furnishing party and giving it a reasonable opportunity to respond. Each
party will utilize reasonable security procedures and protections to assure that records and
documents provided by the other party are not erroneously disclosed to third parties.
ARTICLE XI
RECORDS, DOCUMENTS, AND REPORTS
WSALPHO and its Contractor shall maintain books, records, documents, magnetic media,
receipts, invoices and other evidence relating to this AGREEMENT and the performance of the
services rendered, along with accounting procedures and practices, all of which sufficiently and
properly reflect all direct and indirect costs of any nature expended in the performance of this
AGREEMENT. At no additional cost, these records, including materials generated under this
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AGREEMENT, shall be subject at all reasonable times to inspection, review, or audit by the
LHJ. Records shall be retained for a period of six ( 6) years after the date of final payment.
If any litigation, claim or audit is started before the expiration of the six (6) year period, the
records shall be retained until all litigation, claims, or audit findings involving the records have
been resolved.
ARTICLE XII
TERM AND TERMINATION
This AGREEMENT is effective January 1, 2019, and will terminate 12/31/2019. Either LHJ or
WSALPHO may terminate this AGREEMENT for convenience with written notification to all of
the other signatories to the AGREEMENT no less than ninety (90) calendar days prior to the
beginning of a calendar quarter. The AGREEMENT may be extended for two-year periods with
the written consent of WSALPHO and the MAC Steering Committee.
ARTICLE XIII
AMENDMENTS
Modifications to this AGREEMENT must be in writing and will become effective upon the
approval of the modification by WSALPHO and LHJ.
ARTICLE XIV
INDEPENDENT CAPACITY
The employees or agents ofWSALPHO or LHJ who are engaged in the performance of this
AGREEMENT shall continue to be employees or agents of that party and shall not be considered
for any purpose to be employees or agents of any other party to this AGREEMENT.
ARTICLE XV
SEVERABILITY
If any provision of this AGREEMENT or any document incorporated by reference shall be held
invalid, such invalidity shall not affect the other provisions of this AGREEMENT which can be
given effect without the invalid provision, if such remainder conforms to the requirements of
applicable law and the fundamental purpose of this AGREEMENT, and to this end the
provisions of this AGREEMENT are declared to be severable.
ARTICLE XVI
NO THIRD PARTY BENEFICIARIES
This AGREEMENT is entered into solely for the mutual benefit of the parties to this
AGREEMENT. This AGREEMENT is not entered into with the intent that it shall benefit any
other person and no other such person shall be entitled to be treated as a third-party beneficiary
of this AGREEMENT.
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ARTICLE XVII
DISPUTE RESOLUTION
If a dispute between any parties to this AGREEMENT arises out of or related to this
AGREEMENT, or the breach thereof, and if the dispute cannot be settled through direct
discussions, the parties agree to first endeavor to settle the dispute in an amicable manner by
mediation. Thereafter, any unresolved controversy or claim arising out of or related to this
AGREEMENT, or breach thereof, may be settled in a court having jurisdiction thereof. The
parties may seek to resolve disputes pursuant to mediation or arbitration, but are not required to
do so.
ARTICLE XVIII
NOTICES
Whenever this AGREEMENT provides for notice to be provided by one party to another, such
notice shall be in writing and directed to the Authorized Representatives identified in Article III.
ARTICLE XIX
SURVIVORSHIP
The following clauses survive the termination of this AGREEMENT:
VIII Confidential Information
IX. Immunity, Indemnification, and Limitations
XIV. Severability
XV. No Third Party Beneficiaries
XVI. Dispute Resolution
ARTICLE XX
INSURANCE
WSALPHO shall ensure that any Contractor shall provide insurance coverage as set out in this
section. The intent of the required insurance is to protect WSALPHO should there be any claims,
suits, actions, costs, damages or expenses arising from any negligent or intentional act or
omission of the Contractor or subcontractor, or agents of either, while performing under the
terms of this AGREEMENT.
The Contractor shall provide insurance coverage that shall be maintained in full force and effect
during the term of this AGREEMENT, as follows:
Commercial General Liability Insurance Policy: Provide a Commercial General Liability
Insurance Policy, including contractual liability, in adequate quantity to protect against legal
liability arising out of contract activity but no less than $1,000,000 per occurrence.
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Professional Liability Insurance: Provide a Professional Liability Insurance policy, including
contractual liability, in adequate quantity to protect against legal liability, but no less than
$1,000,000 per claim.
ARTICLEXXI
TERM
The AGREEMENT shall be effective January 1, 2019, and end December 31, 2019.
ARTICLE XXII
OTHER OR PRIOR AGREEMENTS
IfWSALPHO and LHJ have a prior written AGREEMENT that relates to the subject matter of
this AGREEMENT, namely, MAC claiming, then, at such time that WSALPHO and said LHJ
both execute this AGREEMENT, such prior written AGREEMENT between them shall become
null and void and of no further force and effect.
ARTICLE XXIII
GOVERNING LAW
This AGREEMENT shall be interpreted, construed and enforced in accordance with the laws of
the State of Washington.
IN WITNESS WHEREOF, this AGREEMENT has been executed and approved and is effective
and operative by WSALPHO and LHJ as herein provided.
KCPHD WSALPHO
By: By:r 1fw~
a me Bodden
anagingllirector
Date: 1-/(-/1 Date:
8
2019 WORKPLAN
TASK
Task 1: QUARTER START UP ACTIV1TIES
Set up new quarters, send notifications and rem i nders to
A coordinators regarding participant updates . Set up
reconfiguration of consortia as requested by WSALPHO.
Provide assistance with participant updates. Review final
B updates . Perform tasks related to moment generation for
each RMTS on a quarterly basis. Ensure that all processes
are in place prior to moment generation.
Monitor and follow-up with LHJ coordinators for
C participants who have not completed required training.
Ensure participant certifica tions a re completed a nd send
rem i nders as needed to coordinators .
SUBTOTAL TASK 1
Task 2: MANAGING THE RMTS
Monitor RMTS system. Respond to LHJ requests for
technical support or questions via email o r the helpline.
A Follow-up as needed; perform all other daily RMTS
management activities. Manage Docvault. Ma i ntain URMTS
User Guide and MAC calendar; update as needed.
B Prov ide techn ical assistance to URMTS users in navigating
the URMT~ system, as req uested .
C Provide technical assistance to new RMTS Coordinators.
Answer ongoing questions related to RMTS operations .
SUBTOTAL TASK 2
Task 3: TRAINING AND TECHNICAL ASSISTANCE
Set up new participant training for each quarter on URMTS,
A including updated materials and video tutorials. Set up any
additional on line trainings as requested by WSALPHO .
FINAL 11/26/18
CURRENTLY ASSIGNED
STAFF
Riemann/Programmers
Riemann
Riemann/Support Staff
Riemann/Support Staff
Riemann/Programmers
Riemann/Fisher
Riemann/Programmers
Hours I Est. Cost Hours I Est. Cost Hours I Est. Cost
Project Specialist ($115 per Technical Specialist ($90 her
Manager ($150 per hour) hour) hour)
$0 32 $3,680 $0
$0 16 $1,840 $0
$0 16 $1,840 $0
$0 128 $14,720 $0
0 40 4600
32 $4,800 64 $7,360 $0
$0 32 $3,680 $0
,..:, 1t:4ut:::.u::u uy VV.>,..Ll"nu .>lt:t:flll!l ~Ulllllllllt:t:, Uldll
updates and coordinate the review process for web-based
and other established training materials. Trainings will
include new participant training and annual refresher
B training, and any changes or modifications resulting from a Riemann/Fisher 56 $8,400 88 $10,120 0 $0
revised claiming plan or other identified concerns. Post and
update web-based tutorials, training materials and
supporting documents to the RMTS and Claiming System.
As requested by WSALPHO Steering Committee, coordinate
and assist in trainings for LHJ RMTS or fiscal coordinators
that may be scheduled, including drafting materials.
Trainings will include, but are not limited to, RMTS
C management, in person or web-based code reviewer Fisher/Riemann 96
trainings, webi nars for RMTS participants on time survey
$14,400 144 $16,560 0 $0
coding, and annual fiscal refresher training .. As requested
by LHJs, respond to questions about coding issues, SPMP
issues, or other program concerns through emails, phone
calls . or onsite visits.
Work with Provider One/HCA regarding processing of
270/271 documents for the quarterly clinic and client-based
Fisher/Riemann/Program D MERs. Work with HCA on any issues that may surface 8 $1,200 8 $920 0 $0 mers
around the MER; continue dialogue to ensure optimal
matching of MER data.
E Using data supplied by DSHS, prepare the quarterly modified Programmers
countywide MER.
$0 $0 $0
Targeted outreach and training will be provided to LHJs
identified jointly by the LHJ Steering Committee and HFA
F based on issues identified in RMTS participation, coding, Fisher/Riemann 112 $16,800 144 $16,560
coordinator turnover, and/or invoicing. Training will include
the development of LHJ-specific training materials.
Monitor MER online data submissions for processing and
G provide assistance as necessary. Troubleshoot any MER Programmers/Riemann $0
issues with LHJs related to results variance and/or data
16 $1,840 0 $0
problems.
SUBTOTAL TASK 3
T'as:k -4: END OF' Q.UARTER ACTIVtTIEilQA REVIEW/INVOICING
IVIUIIII.UI \..Ull't.JICLIUII UI llllllal n.1v11J IC V ICYV uy LIIJ
coordinators. Review 10% sample of moments by quarter
and by RMTS for accuracy; provide feedback to coordinators
on a regular basis i ncluding use of automated coding review
A module for comments and/or suggestions. Notify lead Fisher/Riemann 88
agency and WSALPHO work group of any late submissions.
$13,200 112 $12 ,880 0 $0
Assist WSALPHO in statewide management of end of
quarter and invoicing processes . Ass ist in any updates
needed to manuals .
Manage/monitor quarterly completion of the RMTS review
B process . Send reminders, notify lead agencies of progress, Riemann/Reynolds $0 40 $4,600 0 $0
update instructions as needed.
As requested by LHJs , provide technical ass istance on
C quest ions related to gatheri ng financi al data needed for the Fisher/Riemann 8 $1,200 16 $1 ,840 $0
web-based claiming system. Assist users with the ontine
invoi ce.
D Ensure that LHJs' RMTS certifications have been
Riemann/Programmers $0 16 $1 ,840 $0
completed; close out the quarter; process RMTS results .
SUBTOTAL TASK 4
Task 5: System Development/Change Requests by Steering Committ~
Work with Steering Committee on any updates to Docvault
Riemann/S chuster/F isher/ A (wh ich houses supporting documentation for RMTS) and 0 $0 16 $1 ,840 0 $0
implement, including loading documents.
Prog rammers
Work with HCA/Steering Committee to create and manage
URMTS change requests.. This inclu des Initiating the c han ge
Riemann/S chuster/Fisher/ B request form, guidin g it thro ug_h the Steering Commi ttee Prog rammers 8 $1,200 64 $7,360 0 $0
.approval process, development of specifications, and
estimated programmatic implementation .
SUBTOTAL TASK 5
Task 6: Technical Assistance to HCA per HCA-W~ALPHO Con~ract
A Draft quarterly reports on SPMP coding and quarterly RMTS Riemann/Fisher/ Schuster 32
QA trend analysis reports as required by contract.
$4,800 64 $7,360 0 $0
Respond to questions from HCA staff on RMTS or invoicing
questions; prepare requested monitori ng reports regarding
Riemann/F is her /Sc huster/ B i nvoice submission status, coding correction status . 16 $2,400 32 $3,680 0 $0
Mainta i n LHJ Contact List . Assist with A19 updates as
Programmers
requested by HCA.
SUBTOTAL TASK 6
Task 7: Meetings (Workgroup. HCA, Consortium. Including Planning and Prep)
Organize and participate in regular RMTS consortia calls;
draft agendas, prepare any handouts and draft summaries,
etc. Assist in planning and facilitating LHJ work group or
coordinator meetings and doing any follow-up, as
requested. Attend HCA meetings as requested. Assist with
A any preparation or follow-up tasks. Assist in implementing
any changes required by CMS or HCA. Participate in
statewide monthly LHJ coordinator calls hosted by HCA.
Respond to requests by workgroup including data gathering,
analysis, and report preparation . Monitor workgroup tasks
;inri nrniPr.t~.
SUBTOTAL TASK 7
Subtotal HFA 2019
WSALPHO (5%)
TOTAL2019
HFA
WSALPHO
atty fee
Full-year Budget
HFA (actual)
atty fee
WSALPHO (actual based on 5% of actual billed)
(1) All programmer time was billed at 1/2
(2) December 2015 billed in 2016
(3) Oct, Nov, Dec 2016 billed in January 2017
Total Actual
Fisher/Riemann
2013
$378,360
$18,918
$0
$397,278
$294,500
$14,725
$309,225
year
2009
2010
2011
2012
160 $24,000
616 l $92,400
2014 2015 (1)(2)
$394,840 $415,360
$19,742 $20,768
$0 $9,500
$414,582 $445,628
$392,857 $434,073
$0 $9,028
$19,643 $21,704
$412,500 $464,805
budget
481,000
480,000
451,000
472,000
256 $29,440 $0
1,3441 $154,560 $0
2016 (3) 2017 2018 2019
$502,222 $395,020 $ 369,940.00 $329,840
$25,111 $19,7S1 $ 18,497.00 $ 16,492.00
$0
$527,333 $414,771 $ 388,437.00 $ 346,332.00
$439,984 $295,856
$0
$21,999 $14,793
$461,983 $295,856
Hours I Est. Cost Hours I Est. Cost
Project Technician ($75 Support ($30 per
per hour) hour)
$0 32 $960
0 $0 16 $480
0 $0 32 $960
$0 32 $960
0 0
$0 $0
$0 0
Hours I Est. Cost
Programmers ($110
16
16
72
8
per hour)
$1,760
$1,760
$0
$0
$7,920
$0
$880
TOTAL COST
$6,400
$4,080
$2,800
$13,280
$15,680
$12,520
$12,160
$40,360
$4,560
$0 $0 16 $1,760 $20,280
$0 $0 $0 $30,960
$0 $0 40 $4,400 $6,520
$0 $0 64 $7,040 $7,040
$0 40 $1,200 $0 $34,560
$0 $0 32 $3,520 $5,360
$109,280
$0 40 $1,200
160 $12,000 0
$0 $0
$0 $0 40
$0 $0 8
$0 $0 256
$0 $0
$0 $0 24
$0
$0
$0
$4,400
$880
$28,160
$0
$2,640
$27,280
$16,600
$3,040
$6,240
$53,160
$2,720
$36,720
$39,440
$12,160
$8,720
$20,880
$0 $0 $0 $53,440
$53__,440
160 $12,000 152 $5,760 592 $65,120 $329,840
$16,492
$346,332
APPENDIXB
BUSINESS ASSOCIATE AGREEMENT
This Agreement ("Agreement") is made and entered into this ...lfil_ day of January, 2019,
by and between Kittias County Public Health ("Covered Entity"), whose business address is
507 N Nanum #102, Ellensburg, WA 98926 and Washington State Associate of Local Public
Health Officials (WSALPHO)_ ("Business Associate"), whose business address is 206 10 th
Ave. SE., Olympia, WA 98501-1311.
WHEREAS, Business Associate is in the business of providing oversight activities of the Health
Care Authority (HCA) working with the Local Health Jurisdiction (LHJ) Medicaid
Administrative Claiming (MAC) Steering Committee to provide coordination and program
compliance among participating LHJ s ("Offering"); and
WHEREAS, Covered Entity wishes to engage, or has engaged, Business Associate in connection
with said Offering,
NOW, THEREFORE, in consideration of the premises and mutual promises herein contained, it
is agreed as follows:
1. Definitions. Terms used, but not otherwise defined in this Agreement, shall have the same
meaning as those terms in the Privacy Rule, Security Rule, and HITECH Act.
a. Agent. "Agent" shall have the meaning as determined in accordance with the federal
common law of agency.
b. Breach. "Breach" shall have the same meaning as the term "breach" in 45 CFR
§164.402.
c. Business Associate. "Business Associate" shall mean WSALPHO.
d. Covered Entity. "Covered Entity" shall mean [Local Health Jurisdiction].
e. Data Aggregation. "Data Aggregation" shall have the same meaning as the term "data
aggregation" in 45 CFR §164.501.
f. Designated Record Set. "Designated Record Set" shall have the same meaning as the
term "designated record set" in 45 CFR §164.501.
g. Disclosure. "Disclosure" and "Disclose" shall have the same meaning as the term
"Disclosure" in 45 CFR § 160.103.
h. Electronic Health Record. "Electronic Health Record" shall have the same meaning as
the term in Section 13400 of the HITECH Act.
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i. Health Care Operations. "Health Care Operations" shall have the same meaning as the
term "health care operations" in 45 CFR § 164.501.
j. HIPAA Rules. "HIPAA Rules" shall mean the Privacy, Security, Breach Notification,
and Enforcement Rules at 45 CFR Part 160 and Part 164.
k. HITECH Act. "HITECH Act" shall mean The Health Information Technology for
Economic and Clinical Health Act, part of the American Recovery and Reinvestment Act of
2009 ("ARRA" or "Stimulus Package"), specifically DIVISION A: TITLE XIII Subtitle D-
Privacy, and its corresponding regulations as enacted under the authority of the Act.
1. Individual. "Individual" shall have the same meaning as the term "individual" in 45 CFR
§ 160.103 and shall include a person who qualifies as a personal representative in accordance
with 45 CFR § 164.502(g).
m. Minimum Necessary. "Minimum Necessary" shall mean the Privacy Rule Standards
found at §164.502(b) and §164.514(d)(l).
n. Privacy Rule. "Privacy Rule" shall mean the Standards for Privacy of Individually
Identifiable Health Information at 45 CFR Part 160 and Part 164, Subparts A and E.
o. Protected Health Information. "Protected Health Information" shall have the same
meaning as the term "protected health information" in 45 CFR §160.103, limited to the
information created, received, maintained or transmitted by Business Associate on behalf of
Covered Entity.
p. Required By Law. "Required By Law" shall have the same meaning as the term
"required by law" in 45 CFR §164.103.
q. Secretary. "Secretary" shall mean the Secretary of the Department of Health and Human
Services or his or her designee.
r. Security Incident. "Security Incident" shall have the same meaning as the term
"Security Incident" in in 45 CFR § 164.304.
s. Security Rule. "Security Rule" shall mean the Standards for Security of Electronic
Protected Health Information at 45 C.F.R. parts §160 and §164, Subparts A and C.
t. Subcontractor. "Subcontractor" shall mean a person or entity "that creates, receives,
maintains, or transmits protected health information on behalf of a business associate" and
who is now considered a business associate, as the latter term is defined in in in 45 CFR
§160.103.
u. Subject Matter. "Subject Matter" shall mean compliance with the HIP AA Rules and
with the HITECH Act.
2
v. Unsecured Protected Health Information. "Unsecured Protected Health Information"
shall have the same meaning as the term "unsecured protected health information" in 45 CFR
§164.402.
w. Use. "Use" shall have the same meaning as the term "Use" in 45 CFR §164.103.
2. Obligations and Activities of Business Associate.
a. Business Associate agrees to not Use or Disclose Protected Health Information other than
as permitted or required by this Agreement or as Required By Law.
b. Business Associate agrees to use appropriate safeguards to prevent Use or Disclosure of
Protected Health Information other than as provided for by this Agreement. Business
Associate further agrees to implement administrative, physical and technical safeguards that
reasonably and appropriately protect the confidentiality, integrity and availability of any
electronic Protected Health Information, as provided for in the Security Rule and as
mandated by Section 13401 of the HITECH Act.
c. Business Associate agrees to mitigate, to the extent practicable, any harmful effect that is
known to Business Associate of a Use or Disclosure of Protected Health Information by
Business Associate in violation of the requirements of this Agreement. Business Associate
further agrees to report to Covered Entity any Use or Disclosure of Protected Health
Information not provided for by this Agreement of which it becomes aware, and in a manner
as prescribed herein.
d. Business Associate agrees to report to Covered Entity any Security Incident, including all
data Breaches or compromises, whether internal or external, related to Protected Health
Information, whether the Protected Health Information is secured or unsecured, of which
Business Associate becomes aware.
e. If the Breach, as discussed in paragraph 2(d), pertains to Unsecured Protected Health
Information, then Business Associate agrees to report any such data Breach to Covered
Entity within ten (10) business days of discovery of said Breach; all other compromises, or
attempted compromises, of Protected Health Information shall be reported to Covered Entity
within twenty (20) business days of discovery. Business Associate further agrees, consistent
with Section 13402 of the HITECH Act, to provide Covered Entity with information
necessary for Covered Entity to meet the requirements of said section, and in a manner and
format to be specified by Covered Entity.
f. If Business Associate is an Agent of Covered Entity, then Business Associate agrees that
any Breach of Unsecured Protected Health Information shall be reported to Covered Entity
immediately after the Business Associate becomes aware of said Breach, and under no
circumstances later than one (1) business day thereafter. Business Associate further agrees
that any compromise, or attempted compromise, of Protected Health Information, other than
a Breach of Unsecured Protected Health Information as specified in 2(e) of this Agreement,
3
shall be reported to Covered Entity within ten ( 10) business days of discovering said
compromise, or attempted compromise.
g. Business Associate agrees to ensure that any Subcontractor, to whom Business Associate
provides Protected Health Information, agrees to the same restrictions and conditions that
apply through this Agreement to Business Associate with respect to such information.
Business Associate further agrees that restrictions and conditions analogous to those
contained herein shall be imposed on said Subcontractors via a written agreement that
complies with all the requirements specified in §164.504(e)(2), and that Business Associate
shall only provide said Subcontractors Protected Health Information consistent with Section
13405(b) of the HITECH Act. Further, Business Associate agrees to provide copies of said
written agreements to Covered Entity within ten (10) business days of a Covered Entity's
request for same.
h. Business Associate agrees to provide access, at the request of Covered Entity and during
normal business hours, to Protected Health Information in a Designated Record Set to
Covered Entity or, as directed by Covered Entity, to an Individual, in order to meet Covered
Entity's requirements under 45 CFR § 164.524, provided that Covered Entity delivers to
Business Associate a written notice at least three (3) business days in advance ofrequesting
such access. Business Associate further agrees, in the case where Business Associate controls
access to Protected Health Information in an Electronic Health Record, or controls access to
Protected Health Information stored electronically in any format, to provide similar access in
order for Covered Entity to meet its requirements the HIP AA Rules and under Section
13405(c) of the HITECH Act. These provisions do not apply if Business Associate and its
employees or Subcontractors have no Protected Health Information in a Designated Record
Set of Covered Entity.
i. Business Associate agrees to make any amendment(s) to Protected Health Information in
a Designated Record Set that Covered Entity directs or agrees to pursuant to 45 CFR
§ 164.526, at the request of Covered Entity or an Individual. This provision does not apply if
Business Associate and its employees or Subcontractors have no Protected Health
Information from a Designated Record Set of Covered Entity.
j. Unless otherwise protected or prohibited from discovery or disclosure by law, Business
Associate agrees to make internal practices, books, and records, including policies and
procedures (collectively "Compliance Information"), relating to the Use or Disclosure of
Protected Health Information and the protection of same, available to the Covered Entity or
to the Secretary for purposes of the Secretary determining Covered Entity's compliance with
the HIP AA Rules and the HITECH Act. Business Associate further agrees, at the request of
Covered Entity, to provide Covered Entity with demonstrable evidence that its Compliance
Information ensures Business Associate's compliance with this Agreement over time.
Business Associate shall have a reasonable time within which to comply with requests for
such access and/or demonstrable evidence, consistent with this Agreement. In no case shall
access, or demonstrable evidence, be required in less than five (5) business days after
Business Associate's receipt of such request, unless otherwise designated by the Secretary.
4
k. Business Associate agrees to maintain necessary and sufficient documentation of
Disclosures of Protected Health Information as would be required for Covered Entity to
respond to a request by an Individual for an accounting of such Disclosures, in accordance
with 45 CFR § 164.528.
1. On request of Covered Entity, Business Associate agrees to provide to Covered Entity
documentation made in accordance with this Agreement to permit Covered Entity to respond
to a request by an Individual for an accounting of disclosures of Protected Health Information
in accordance with 45 C.F .R. § 164.528. Business Associate shall provide said documentation
in a manner and format to be specified by Covered Entity. Business Associate shall have a
reasonable time within which to comply with such a request from Covered Entity and in no
case shall Business Associate be required to provide such documentation in less than three
(3) business days after Business Associate's receipt of such request.
m. Except as provided for in this Agreement, in the event Business Associate receives an
access, amendment, accounting of disclosure, or other similar request directly from an
Individual, Business Associate shall redirect the Individual to the Covered Entity.
n. To the extent that Business Associate carries out one or more of Covered Entity's
obligations under the HIP AA Rules, the Business Associate must comply with all
requirements of the HIP AA Rules that would be applicable to the Covered Entity.
o. A Business Associate must honor all restrictions consistent with 45 C.F .R. § 164.522 that
the Covered Entity or the Individual makes the Business Associate aware of, including the
Individual's right to restrict certain disclosures of protected health information to a health
plan where the individual pays out of pocket in full for the healthcare item or service, in
accordance with HITECH Act Section 13405(a).
3. Permitted Uses and Disclosures by Business Associate.
a. Except as otherwise limited by this Agreement, Business Associate may make any Uses
and Disclosures of Protected Health Information necessary to perform its services to Covered
Entity and otherwise meet its obligations under this Agreement, if such Use or Disclosure
would not violate the Privacy Rule, or the privacy provisions of the HITECH Act, if done by
Covered Entity. All other Uses or Disclosures by Business Associate not authorized by this
Agreement, or by specific instruction of Covered Entity, are prohibited.
b. Except as otherwise limited in this Agreement, Business Associate may Use Protected
Health Information for the proper management and administration of the Business Associate
or to carry out the legal responsibilities of the Business Associate.
c. Except as otherwise limited in this Agreement, Business Associate may Disclose
Protected Health Information for the proper management and administration of the Business
Associate, provided that Disclosures are Required By Law, or Business Associate obtains
reasonable assurances from the person to whom the information is Disclosed that it will
remain confidential and used, or further Disclosed, only as Required By Law, or for the
5
purpose for which it was Disclosed to the person, and the person notifies the Business
Associate of any instances of which it is aware in which the confidentiality of the
information has been breached.
d. Except as otherwise limited in this Agreement, Business Associate may Use Protected
Health Information to provide Data Aggregation services to Covered Entity as permitted by
45 CFR § 164.504( e )(2)(i)(B). Business Associate agrees that such Data Aggregation services
shall be provided to Covered Entity only wherein said services pertain to Health Care
Operations. Business Associate further agrees that said services shall not be provided in a
manner that would result in Disclosure of Protected Health Information to another covered
entity who was not the originator and/or lawful possessor of said Protected Health
Information. Further, Business Associate agrees that any such wrongful Disclosure of
Protected Health Information is a direct violation of this Agreement and shall be reported to
Covered Entity immediately after the Business Associate becomes aware of said Disclosure
and, under no circumstances, later than three (3) business days thereafter.
e. Business Associate may Use Protected Health Information to report violations of law to
appropriate Federal and State authorities, consistent with § 164.5020)(1 ).
f. Business Associate shall make Uses, Disclosures, and requests for Protected Health
Information consistent with the Minimum Necessary principle as defined herein.
4. Obligations and Activities of Covered Entity.
a. Covered Entity shall notify Business Associate of the provisions and any limitation(s) in
its notice of privacy practices of Covered Entity in accordance with 45 CFR § 164.520, to the
extent that such provisions and limitation(s) may affect Business Associate's Use or
Disclosure of Protected Health Information.
b. Covered Entity shall notify Business Associate of any changes in, or revocation of,
permission by an Individual to use or disclose Protected Health Information, to the extent
that the changes or revocation may affect Business Associate' s use or disclosure of Protected
Health Information.
c. Covered Entity shall notify Business Associate of any restriction to the use or disclosure
of Protected Health Information that Covered Entity has agreed to in accordance with 45
CFR § 164.522, and also notify Business Associate regarding restrictions that must be
honored under section 13405(a) of the HITECH Act, to the extent that such restrictions may
affect Business Associate's Use or Disclosure of Protected Health Information.
d. Covered Entity shall notify Business Associate of any modifications to accounting
disclosures of Protected Health Information under 45 CFR §164.528, made applicable under
Section 13405( c) of the HITECH Act, to the extent that such restrictions may affect
Business Associate's use or disclosure of Protected Health Information.
6
e. Covered Entity shall provide Business Associate, within thirty (30) business days of
Covered Entity executing this Agreement, a description and/or specification regarding the
manner and format in which Business Associate shall provide information to Covered Entity,
wherein such information is required to be provided to Covered Entity as agreed to by
Business Associate in paragraph 2(e) of this Agreement. Covered Entity reserves the right to
modify the manner and format in which said information is provided to Covered Entity, as
long as the requested modification is reasonably required by Covered Entity to comply with
the HIP AA Rules or the HITECH Act, and Business Associate is provided sixty (60)
business days notice before the requested modification takes effect.
f. Covered Entity shall provide Business Associate, within thirty (30) business days of
Covered Entity executing this Agreement, a description and/or specification regarding the
manner and format in which Business Associate shall provide information to Covered Entity,
wherein such information is required to be provided to Covered Entity as agreed to by
Business Associate in paragraph 2(1) of this Agreement. Covered Entity reserves the right to
modify the manner and format in which said information is provided to Covered Entity, as
long as the requested modification is reasonably required by Covered Entity to comply with
the HIP AA Rules or the HITECH Act, and Business Associate is provided sixty (60)
business days notice before the requested modification takes effect.
g. Covered Entity shall not require Business Associate to Use or Disclose Protected Health
Information in any manner that would not be permissible under the HIP AA Rules if done by
the Covered Entity.
5. Term and Termination.
a. Term. The Term of this Agreement shall be effective as of January 1, 2019 [Effective
Date], and shall terminate when all of the Protected Health Information provided by Covered
Entity to Business Associate, or created or received by Business Associate on behalf of
Covered Entity, is destroyed or returned to Covered Entity, or, if it is infeasible to return or
destroy Protected Health Information, protections are extended to such information, in
accordance with the termination provisions in this Agreement.
b. Temrination for Cause by Covered E ntity . Upon Covered Entity's knowledge of a
material breach of this Agreement by Business Associate, Covered Entity shall give Business
Associate written notice of such breach and provide reasonable opportunity for Business
Associate to cure the breach or end the violation. Covered Entity may terminate this
Agreement, and Business Associate agrees to such termination, if Business Associate has
breached a material term of this Agreement and does not cure the breach or cure is not
possible. If neither termination nor cure is feasible, Covered Entity shall report the violation
to the Secretary.
c. Termin ation for Cause by Busin~ss Associate. Upon Business Associate's knowledge of a
material breach of this Agreement by Covered Entity, Business Associate shall give Covered
7
Entity written notice of such breach and provide reasonable opportunity for Covered Entity
to cure the breach or end the violation. Business Associate may terminate this Agreement,
and Covered Entity agrees to such termination, if Covered Entity has breached a material
term of this Agreement and does not cure the breach or cure is not possible. If neither
termination nor cure is feasible, Business Associate shall report the violation to the Secretary.
d. Effect of Termination.
1. Except as provided in paragraph (2) of this section, upon termination of this
Agreement for any reason, Business Associate shall return or destroy all Protected
Health Information received from, or created or received by Business Associate on behalf
of Covered Entity. This provision shall also apply to Protected Health Information that is
in the possession of Subcontractors of Business Associate. Business Associate shall retain
no copies of the Protected Health Information.
2. In the event that Business Associate determines that returning or destroying the
Protected Health Information is infeasible, Business Associate shall provide to Covered
Entity, within ten (10) business days, notification of the conditions that make return or
destruction infeasible. Upon such determination, Business Associate shall extend the
protections of this Agreement to such Protected Health Information and limit further uses
and disclosures of such Protected Health Information to those purposes that make the
return or destruction infeasible, for so long as Business Associate maintains such
Protected Health Information.
6. Entire Agreement.
a. This Agreement supersedes all other prior and contemporaneous written and oral
agreements and understandings between Covered Entity and Business Associate regarding
this Subject Matter. It contains the entire Agreement between the parties.
b. This Agreement may be modified only by a signed written agreement between Covered
Entity and Business Associate.
c. All other agreements entered into between Covered Entity and Business Associate, not
related to this Subject Matter, remain in full force and effect.
7. Governing Law.
a. This Agreement and the rights of the parties shall be governed by and construed in
accordance with Federal law as it pertains to the Subject Matter and shall be governed by and
construed in accordance with the laws of the State of Washington as it pertains to contract
formation and interpretation, without giving effect to its conflict oflaws. The parties agree
that any appropriate state court sitting in Benton County, Washington or any Federal Court
sitting in the Eastern District of Washington shall have exclusive jurisdiction of any case or
controversy arising under or in connection with this Agreement and shall be a proper forum
in which to adjudicate such case or controversy.
8
b. Each party irrevocably consents to the jurisdiction of such courts , and irrevocably waives,
to the fullest extent permitted by law, the defense of an inconvenient forum to the
maintenance of such suit, action, or proceeding in any such court and further waives the right
to object, with respect to such suit, action, or proceeding, that such court does not have
jurisdiction over such party.
8. Miscellaneous.
a. R e gul ato ry R eferences. A reference in this Agreement to a section in the Privacy Rule,
Security Rule, or HITECH Act means the section as in effect or as amended.
b. Amendment. The Parties agree to take such action as is necessary to amend this
Agreement from time to time as is necessary for Covered Entity and Business Associate to
comply with the requirements of the Privacy Rule, Security Rule, the Health Insurance
Portability and Accountability Act of 1996 (Pub. L. No. 104-191 ), and the HITECH Act, and
its corresponding regulations.
c. Survival. The respective rights and obligations of Business Associate under Section 5( d)
of this Agreement shall survive the termination of this Agreement.
d. Inte rpretation. Any ambiguity in this Agreement shall be resolved to permit Covered
Entity and Business Associate to comply with the Privacy Rule, Security Rule, the Health
Insurance Portability and Accountability Act of 1996 (Pub. L. No. 104-191), and the
HITECH Act, and its corresponding regulations.
e. Severability. If any provision or provisions of this Agreement is/are determined by a
court of competent jurisdiction to be unlawful, void, or unenforceable, this Agreement shall
not be unlawful, void or unenforceable thereby, but shall continue in effect and be enforced
as though such provision or provisions were omitted.
9. Counterparts.
This Agreement may be executed in any number of counterparts, each of which shall be deemed
an original, but all of which together shall constitute one original Agreement. Facsimile or
electronically authenticated signatures shall be accepted and enforceable in lieu of original
signatures.
9
APPROVED AND ACCEPTED BY:
Business Associate:
Washington State Association of Local Public Health Officials
Date
/--If-I
Tristen Lamb Date
Title: KCPHD Ad istrator
Phone: (509)962-7515
10
Kittitas County
Review Form
Grants & Contract Agreement # L/bD50
Today's Date Agenda Date \)\to\lB 12/10/2018
Fund/Department
116 -Public Health
Cont ract /Grant Information
Contract /Grant Agency : Washington State Association of Local Public Health Officials and Kittitas County
Public Health Department
Period Begin Date : 01/01/2019 I I Period End Date: 12/31/2019
Total Gra nt/Co ntract Amount : $ Fee for service
Grant/Contract Number:
Contract/Grant Summary:
The Washington State Associate of Local Public Health Officials formalizes the understanding between
the Washington State Association of Local Public Health Officials (WSALPHO) and Local Health
Jurisdiction Kittitas County Public Health regarding the operation of the Medicaid Administrative
Claiming in Washington State . Attached is also the Business Associate Agreement needed to satisfy the
Health Insurance and Accountability Act.
Recommendation for Board of Health and Board of Health Review on
Department Head Signatu
Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment:
AP P. DAS TO FORM :
Date
Signature of Board of Health member Date
Financial Information
I Total Amount$ no max I State Funds$ I Federal Funds$ no max
Grant/Contract Review Page 1
Percentage County Funds Matching Funds$ ] CFDA# 93.778
In-Kind$
Explain
Is Equipment being purchased? Who owns equipment?
New Personnel being hired? Contact HR hiring-reporting requirements
Future impacts or liability to Kittitas County:
Budget Information
Budget Amendment Needed? Yes • attach budget form No []j Why not
New Division Created? Included in budget process
Revenue Code 116.612.95.333.93.778---no max
Pass Through Information
Agency to Pass Through
Amount to Pass Through $
Sub-Contract Approved Date:
Prosecutor Review
I Has the Prosecutor reviewed this agreement? I Yes • No D
County Departments Impacted
Auditor Facilities Maintenance
Information Services Human Resource
Prosecutor Treasurer
-
Submitted I Signature:
Department:
I Date :
Assignment of Tracki ng Information
-
Auditor's Office
Human Resource
Prosecutor's Office
Who Signed the grant application
I Reviewer I Date
Grant/Contract Review Page 2