02/19/2003 Agreement
Clerk Dl1he
Circul coun
Danny L. Kolhage
Office (305) 292-3550 Fax (305) 295-3663
Memnrandum
To:
Louis LaTorre, Director
Social Services
Isabel C. DeSantis, J _~)
Deputy Clerk J1Y
From:
Date:
Monday, March 31, 2003
At the BaCC meeting of February 19, 2003, the Board approved the following:
Data Sharing Agreement between Monroe County and the State of Florida,
Agency for Health Care Administration to maintain privacy of health information as
required under HIP AA, regarding the Medicaid billing program.
Enclosed please find three fully-executed duplicate originals of the subject
Agreement for your handling.
Should you have any questions, please do not hesitate to contact this office.
cc: Finance
County Attorney
File ..,,/
DA T A SHARING AGREEMENT
This agreement is entered by and between the State of Florida, Agency for Health Care
Administration, hereinafter referred to as the Agency, and Monroe County, hereinafter referred
to as the County.
Whereas, the Agency shall make available to the County certain data that is confidential
and must be afforded special treatment and protection; and,
Whereas, the County shall receive and have access to data from the Agency that can be
used or disclosed only in accordance with this agreement and state and federal law;
Now, therefore, the Agency and the County agree as follows:
1. Purpose of A2reement. The County represents, and in furnishing the data specified in
this agreement the Agency relies upon such representation, that the data specified in this
agreement will be used solely for purposes of Medicaid services pursuant to Section
409.915, Florida Statutes (2002).
2. Justification for Access. This agreement is authorized by law under section 1902(a)(7)
of the Social Security Act. Section 1902(a)(7) of the Social Security Act mandates that a
State Medicaid Plan provide safeguards that restrict the use or disclosure of information
concerning applicants and recipients to purposes directly connected with the
administration of the Plan. This agreement implements this statute by allowing the
Agency to disclose the data necessary for the administration of the Medicaid program.
3.
Description of Data. To enable the County to contribute its share of matchin~un~s ~~
required for the Medicaid program, the Agency may disclose invoices for cert~ items ~
care and service for which the Agency has determined the County has financi~~lity~
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Point of Contact. The Agency designates the following individual as the Ag~:.:S point
of contact for this agreement: ~~~~: 5":
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David Herman, AHCA Privacy Officer
Name of point of contact
2727 Mahan Drive, Mail Stop 1, Bldg 3, Mail Stop 1
Street address
Tallahassee, Florida 32308
City/ State/ Zip code
850-488-2734
Phone number
All correspondence regarding this agreement, including, but not limited to, notification of
change of custodianship, uses or disclosures of the data not provided for by this
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agreement, requests for access to the data, requests for accounting of disclosures of the
data, disposition of the data, and termination of this agreement, shall be addressed to the
point of contact.
5. Custodial Responsibilitv. The County names the following individual custodian of the
data on behalf of the County:
Louis LaTorre
Name of custodian
1100 Simonton Street
Street Address
Key West, FL 33040
City/ State/ Zip code
305/292-4573
Phone number
The custodian shall be responsible for the observance of all conditions of use and for the
establishment and maintenance of safeguards as specified in this agreement to prevent
unauthorized use. The County shall notify the Agency in writing within fifteen (15) days
of any change of custodianship. Notification of change of custodianship shall be
delivered by certified mail, return receipt requested, or in person with proof of delivery.
6. Permissible Uses and Disclosures of Aeencv Data. The County shall not use or further
disclose the data specified in this agreement except as permitted by this agreement or as
required by federal law. The County shall establish appropriate administrative, technical,
and physical safeguards to protect the confidentiality of and to prevent unauthorized use
or access to the data specified in this agreement.
The County shall not release or allow the release of the data specified in this agreement to
any persons or entities other than as permitted by this agreement.
The County shall restrict disclosure of the data specified in this agreement to the
minimum number of individuals who require the information in order to perform the
functions of this agreement. The County shall instruct individuals to whom the data is
disclosed of all obligations under this agreement and shall require the individuals to
maintain those obligations.
The County shall secure the data specified in this agreement when the data is not under
the direct and immediate control of an authorized individual performing the functions of
this agreement. The County shall make a good faith effort to identify any use or
disclosure of the data not provided for by this agreement. The County shall notify the
Agency by certified mail, return receipt requested, or in person with proof of delivery
within seventy-two (72) hours of discovery of any use or disclosure of the data not
provided for by this agreement of which the County is aware.
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A violation of this section shall constitute a material breach of this agreement.
7. Disclosure to A2ents. The County shall ensure that any agents of the County, including,
but not limited to, a contractor or subcontractor, to whom the County provides the data
specified in this agreement agree to the same terms, conditions, and restrictions that apply
to the County with respect to the data.
8. Access to the Data. The County shall notify the Agency in writing by certified mail,
return receipt requested, or in person with proof of delivery within ten (10) days of any
requests received by the County from individuals seeking access to or copies of the data
specified in this agreement.
9. Accountin2 of Disclosures. The County shall notify the Agency in writing by certified
mail, return receipt requested, or in person with proof of delivery within ten (10) days of
any requests received by the County from individuals seeking an accounting of
disclosures of the data specified in this agreement. The County shall document all
disclosures of the data as needed for the Agency to respond to a request for an accounting
of disclosures in accordance with 45 C.F.R. ~ 164.528, and shall provide the Agency with
such documentation upon the Agency's request.
10. Incorporation of Amendments to the Data. The County shall incorporate any
amendments to the data specified in this agreement when and as notified by the Agency.
11. Penalties. The County acknowledges that failure to abide by the terms of this
agreement may subject the County to penalties for wrongful disclosure of protected
health information under federal law . The County shall inform all persons with
authorized access to the data specified in this agreement of the penalties for wrongful
disclosure of protected health information.
12. Indemnification. To the extent permitted by federal and state law, the County agrees to
indemnify, defend, and hold harmless the Agency from any or all claims and losses
accruing to any person, organization, or other legal entity as a result of violation of this
Agreement.
13. Disposition of Data. The County may retain the data specified in this agreement for a
period not to exceed five (5) years from the date the County receives or is provided
access to the data, hereinafter referred to as the retention period. Upon conclusion of the
retention period, the County shall destroy the data and any information derived from its
contents, including all copies, modified data, or hybrid or merged databases containing
the data. The County shall provide the Agency with written confirmation of the
destruction of the data and any information derived from its contents.
14. Term of A2reement. This agreement shall be effective upon execution by both parties
and shall remain in effect until April 1, 2008 or until terminated by one of the parties.
The Agency may, by no less than twenty-four (24) hours written notice to the County,
terminate this agreement upon material breach of this agreement. This agreement may be
terminated by either party without cause upon thirty (30) days written notice. Notice of
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termination shall be delivered by certified mail, return receipt requested, or in person
with proof of delivery.
The terms of this agreement may not be waived, altered, modified, or amended except by written
agreement of both parties.
This agreement supersedes any and all agreements between the parties with respect to the use of
the data specified in this agreement.
In witness whereof, the Agency and the County have caused this agreement to be signed and
delivered by their duly authorized representatives as of the date set forth below.
For Monroe County
L)~ >n ~~
Signature
Dixie Spehar
Print Name
Mayor
Title
3/19/03
Date
For the Agency for Health Care Administration
Si~a~ ~
l?x:b Shupe
Print Name
~~ Q,yMedJro-lJ
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Date
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'~~y L. KOLHAGE, CLERK
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DEPUTY CLER
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