VAN BUREN/CASS
DISTRICT HEALTH DEPARTMENT
VAN BUREN COUNTY
Human Services Building-West57418 CR 681, Suite A
HartfordMI 49057
Telephone (269) 621-3143
Fax (269) 621-2725 / MEDICAL DIRECTOR
Frederick (Rick) Johansen, MD, MPH
DEPUTY MEDICAL DIRECTOR
Rex Cabaltica, MD MPH
ADMINISTRATOR/HEALTH OFFICER
Jeffery L Elliott, BBA /
CASSCOUNTY
201 M-62 NorthCassopolis MI 49031
Telephone (269) 445-5280
Fax (269) 445-5278
May 4, 2007
HIPAA Regulation Requirements
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule under Federal Regulation was enacted to increase the level of patient privacy protection as well as to offer additional individual rights to protect health information. One of the elements of HIPAA calls on covered entities (like ourselves) to procure contractual assurances from Business Associates that PHI (Personal Health Information) will be sufficiently secured when shared for business purposes.
The Business Associate Agreement is basically your acknowledgment that you have documentation incorporated restricting the uses and disclosures protecting PHI, other than as permitted or required by the contract or as required by law; and requires the use of appropriate safeguards to prevent a use or disclosure of the PHI other than as provided for by the contract. Attached is our Business Associate Contract. Please sign where indicated, make a copy for your records and return the original in the self-addressed stamp enveloped enclosed.
Sincerely,
Tina Cox
Administrative Assistant
Compliance Officer
BUSINESS ASSOCIATES PHI
(PERSONAL HEALTH INFORMATION)
PRIVACY AGREEMENT
THIS CONTRACT is entered into on this 4th day of May 2007, between Van Buren/Cass District Health Department (Cover Entity) and Alicia Parsayar (Business Associate).
WHEREAS, Van Buren/Cass District Health Department will make available to the Business Associate certain information, in conjunction with goods or services provided by the Business Associate to Van Buren/Cass District Health Department that is confidential and must be treated and protected as such.
WHEREAS,the Business Associate will have access to and/or receive from Van Buren/Cass District Health Department certain information that can be used or disclosed only in accordance with this Contract and the HHS (Health & Human Services) Privacy Regulations.
NOW, THEREFORE, Van Buren/Cass District Health Department and the Business Associate agree as follows:
TERM. The term of this contract shall commence at time of signature (Effective Date), and shall expire when all of the information provided by Van Buren/Cass District Health Department to Business Associate is destroyed or returned to Van Buren/Cass District Health Department.
LIMITS ON USE AND DISCLOSURE ESTABLISHED BY TERMS OF CONTRACT OR LAW. The Business Associate hereby agrees that it shall not use or disclose the information provided or made available by Van Buren/Cass District Health Department for any purpose other than as permitted by this contract or required by law. The Business Associate shall not use or disclose information in a manner that would violate HHS privacy regulations.
PERMITTED USES AND DISCLOSURES OF INFORMATION BY BUSINESS ASSOCIATE. The Business Associate shall be permitted to use and/or disclose information provided or made available from Van Buren/Cass District Health Department for the following stated purpose:
- The Business Associate may de-identify the information provided that the Business Associate satisfies the applicable provisions for de-identification under the Privacy Regulations and provides the Covered Entity with written documentation as required by said provision. Any such de-identified information shall not constitute information and shall not be subject to the terms and conditions of this agreement.
USE OR DISCLOSURE OF INFORMATION FOR MANAGEMENT, ADMINISTRATION OF BUSINESS, AND LEGAL RESPONSIBILITIES. The Business Associate may use the information if necessary for the proper management and administration of the Business Associate; to carry out legal responsibilities; and to provide data aggregation services relating to the health care operations of Van Buren/Cass District Health Department. The Business Associate may also disclose information provided, if:
- The law requires the disclosure; or
- The Business Associate obtains reasonable assurances from the person(s) to who the information is disclosed that it will be held confidential and used or further disclosed only as required by law, or for the purposes for which it was disclosed to the person; and the person promptly notifies the Business Associate of any instances of which it is aware that the confidentiality of the information has been breached.
OBLIGATIONS OF BUSINESS ASSOCIATE:
a.Appropriate Safeguards: The Business Associate will use appropriate safeguards to prevent use or disclosure of information other than as provided for by this contract.
b.Reporting Improper Use or Disclosure: The Business Associate will report to Van Buren/Cass District Health Department any use or disclosure of information not provided for by this contract of which it becomes aware.
c.Agents and Subcontractors. The Business Associate shall ensure by subcontract that agents or subcontractors to whom it provides or makes available information, will be bound by the same restrictions and conditions on the use of information that apply to the Business Associate and that are contained in this contract.
d.Individuals’ Right of Access, Amending Information and Accounting of Disclosures: The Business Associates shall make available information in accordance with individual rights to access, right to amend information and provide an accounting of disclosure of client information in accordance with 45 C.F.R. 164.524, 164.528, and 164.528 including substitutions of the words “Covered Entity” with Business Associate where appropriate.
e.Access to Books and Records: The Business Associate shall make its internal practices, books and records relating to the use or disclosure of protected health information received from, or created or received by the Business Associate on behalf of Van Buren/Cass District Health Department, available to the Secretary of HHS for the purposes of determining compliance with HHS Privacy Regulations.
f.Return or Destruction of Information: At termination of Contract, the Business Associate will return or destroy all protected health information received from, or created or received by the Business Associate on behalf of Van Buren/Cass District Health Department. The Business Associate shall not retain copies of such information upon termination of Contract. If returning or destroying information at termination of contract is not feasible, the Business Associate will extend the information protections of this Contract and limit further uses and disclosures to those purposes that make the return or destruction of information infeasible.
g.Minimum Necessary: The Business Associate shall not request from the Covered Entity, or provide to any third party or other entity in connection with any of its permitted uses and/or disclosures of information, as set forth in this Agreement, more information than the minimum necessary for the Business Associate to carry out its obligations, functions or services.
OBLIGATIONS OF COVERED ENTITY:
- Inform the Business Associate of any change in or revocation of any consent or authorization provided to the Covered Entity by individuals pursuant to applicable law, including but not limited to, the HIPAA Privacy Regulations and which is applicable to the Business Associate.
- Notify the Business Associate in a timely manner, in writing, of any arrangement permitted or required of the Covered Entity under applicable law, including, but not limited to, the HIPAA Privacy Regulations, that may impact in any manner the use or disclosure of the information by the Business Associate under this Agreement, including but not limited to, any agreement by the Covered Entity to restrict use or disclosure of any information as permitted by the HIPAA Privacy Regulations.
TERMINATION OF CONTRACT: The Business Associate agrees that the Van Buren/Cass District Health Department may immediately terminate this contract if the Van Buren/Cass District Health Department determines that the Business Associate has violated a material term of this contract.
APPLICABLE LAW: The law of the State of Michigan shall govern this contract.
FORCE MAJEURE: The Business Associate shall be excused from performance of this contract for any period the Business Associate is prevented from performing any services pursuant hereto because of an Act of God, War, Civil Disturbance, Court Order, Labor Dispute or other cause beyond the control of the Business Associate.
INDEMNIFICATION AND HOLD HARMLESS: In the event that a party releases information in violation of the terms and conditions of this agreement, the Breaching Party shall indemnify and hold harmless the other party from any losses or costs incurred resulting from the release of information by the breaching party in violation of the terms and conditions of this agreement. A party which has released the information in compliance with the provisions of the agreement, however, shall not be required to comply with such indemnification obligation.
CHANGE IN LAW: Both parties agree in good faith to make any modification of this agreement that may be necessary or required to ensure consistency with any amendments to or change in applicable law, including, but not limited to, the HIPAA Privacy Regulations.
NOTICES: Any notice, request or other communication to be given by either party to this agreement, shall be in writing and shall be addressed as follows:
Van Buren/Cass District Health Department57418 CR 681
HartfordMI 49057
Attn: Jeffery Elliott, Health Officer
Alicia Maria Parsayar829 South LaGrave Street
Paw Paw MI 49079
IN WITNESS WHEREOFAlicia Parsayarand Van Buren/Cass District Health Department have agreed to the terms of the above written agreement as of the Effective Date set forth above.
Van Buren/Cass District Health DepartmentAlicia Maria Parsayar
______
BYBY
Jeffery L Elliott______
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Administrator/Health Officer______
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