HomeMy WebLinkAboutAddenda - CONTRACT - P740 EMPLOYEE ASSISTANCEHIPAA HEALTH INFORMATION PRIVACY AMENDMENT TO
SERVICE AGREEMENT
WHEREAS, the City of Fort Collins, Colorado (the "Plan Sponsor") and
Employee Assistance Programs International, Inc., a subsidiary of Horizon Behavioral
Services, Inc. (the "Plan") wish to amend their Professional Services Agreement signed
by the Plan Sponsor on March 24, 2000 (the "Agreement") so as to incorporate privacy
requirements of the Health Insurance Portability and Accountability Act.
NOW, THEREFORE, BE IT RESOLVED, effective April 14, 2003, the Agreement
is hereby amended by adding the following provisions:
PROVISION OF PROTECTED HEALTH INFORMATION TO PLAN SPONS611
1. Permitted and Required Uses and Disclosure of Protected Wealth
Information. Unless otherwise permitted by law, and subject to obtaining %vritten
certification pursuant to Section 4 of this Amendment, the Plan may disclose Protected
Heath Information to the Plan Sponsor, provided the Plan Sponsor uses or discloses
such Protected Health Information only for the following purposes:
a. Performing Plan Administration Functions, which the Plan S14onsor
performs for the Plan. I
b. Obtaining premium bids from insurance companies or other health
plans for providing insurance coverage under or on behalf bf the
group health plan; or
c. Modifying, amending, or terminating the group health plan
Notwithstanding the provisions of this Plan to the contrary, in no event shall the
Plan Sponsor be permitted to use or disclose Protected Health Information in a manner
that is inconsistent with 45 CFR § 164.504(f).
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2. Information Regarding Participation. Notwithstanding Section 1 df this
Amendment, the Plan may disclose to the Plan Sponsor information on whethar the
individual is participating in the Plan or is enrolled in or has disenrolled from the Plan.
3. Conditions of Disclosure. Plan Sponsor agrees that with respect tb any
Protected Health information disclosed to it by the Plan, Plan Sponsor shall:
a. Not use or further disclose the Protected Health Information other
than as permitted or required by the Plan or by law.
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b. Ensure that any agents, including a subcontractor, to whom it
Provides Protected Health Information received from the Plan agree
to the same restrictions and conditions that apply to the Plan
Sponsor, with respect to Protected Health Information,
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C. Not use or disclose the Protected Health Information for
employment -related actions and decisions or in connection with any
other benefit or employee benefit plan of the Plan Sponsor, unless
permitted by law.
d. Report to the Plan any use or disclosure of the information that i5
inconsistent with the uses or disclosures provided for of which it
becomes aware.
e. Make available Protected Health Information in accordance with 45
CFR § 164,524.
f. Make available Protected Health Information for amendment and
incorporate any amendments to Protected Health Information in
accordance with 45 CFR § 164.528.
g. Make available the information required to provide an accounting of
disclosures in accordance with 45 CFR § 164.528.
h. Make its internal practices, books, and records relating to the use
and disclosure of Protected Health Information received from the
Plan available to the Secretary of Health and Human Services for
purposes of determining compliance by the Plan with subpart E of
45 CFR § 164.
i. If feasible, return or destroy all Protected Health Information
received from the Plan that the Plan Sponsor still maintains in any
form and retain no copies of such information when no longer
needed for the purpose for which disclosure was made, except that,
if such return or destruction is not feasible, limit further uses and
disclosures to those purposes that make the return or destruction of
the information infeasible,
Ensure that the adequate separation between Plan and Plan
Sponsor, required in 45 CFR § 504(f)(2)(iii), is satisfied.
4. Certification of Plan Sponsor, The Plan shall disclose Protected Health
Information to the Plan Sponsor only upon the receipt of a certification by the Plan
Sponsor that the Plan has been amended to incorporate the provisions of 45 CFR
§ 164.504(f)(2)(ii), and that the Plan Sponsor agrees to the conditions of disclosure set
forth in Section 3 of this Amendment. The Plan shall not disclose Protected Health
Information to the Plan Sponsor as otherwise permitted herein unless the statement
required by 45 CFR § 164.520(b)(1)(i) is included in the appropriate notice.
5. Adequate Separation Between Plan and Plan Sponsor. The Plan
Sponsor shall only allow its Benefits Administrator, its Director of Human Resources, its
Benefits work group within the Human Resources Department, and its legal and
systems personnel who perform functions related to the Plan access to the Protected
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Health Information. These specified employees shall only have access to and use
Protected Health Information to the extent necessary to perform the Plan Administration
Functions that the Plan Sponsor performs for the Plan. In the event that any of these
specked employees do not comply with the provisions of this Section 5, that employee
shall be subject to disciplinary action by the Plan Sponsor for non-compliance pursuant
to the Plan Sponsor's employee discipline and termination procedures.
6. Permitted Uses and Disclosure of Summary Health Information.
Notwithstanding Section 1 of this Amendment, the Plan may disclose Summary Health
Information to the Plan Sponsor, provided the Plan Sponsor requests the Summary
Health Information for the purpose of.
a. Obtaining premium bids from health plans for providing health
insurance coverage under the Plan; or,
b. Modifying, amending, or terminating the Plan.
7. Definitions. The definitions of capitalized terms used herein attached
hereto are incorporated herein by reference and constitute a part hereof.
IN WITNESS WHEREOF, this Amendment has been adopted by the Plan
Sponsor and signed by a duly authorized representative of the Plan Sponsor with the
authority to amend the terms of the Plan and has been approved by the Plan. This
Amendment may be relied upon by Plan officials, Covered Entities (as defined by the
HIPAA Privacy Regulation), and business associates with respect to the Agreement.
Plan Sponsor:
The City of Fort Collins
9thorized Signature
Name: James B. O'Neill 11, CPPO
Title: Director of Purchasing and Risk Mgt.
Plan:
Employee Assistance Programs
International, Inc., a subsidiary of Horizon
Behavioral Services, Inc.
By:�`'6W
Authorized Signafure
Name: '&V Litz- Ero
Title: � P (i
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DEFINITIONS
Covered Entity means:
(1) A Health Plan
(2) A health care clearinghouse; or
(3) A health care provider who transmits any Health Information in electronic
form in connection with a Transaction.
Health Information means any information, whether oral or recorded in any form or
medium, that:
(1) Is created or received by a health care provider, Health Plan, public health
authority, employer, life insurer, school or university, or health care
clearinghouse; and
(2) Relates to the past, present or future physical or mental health or
condition of an individual; the provision of health care to an individual; or
the past, present, or future payment for the provision of health care to an
individual.
Individually Identifiable Health Information means a subset of Health Information,
including demographic information collected from an individual, and:
(1) Is created or received by a health care provider, Health Plan, employer, or
health care clearinghouse; and
(2) Relates to the past, present, or future physical or mental health or
condition of an individual; the provision of health care to an individual; or
the past, present, or future payment for the provision of health care to an
individual; and
(i) That identifies the individual; or
With respect to which there is a reasonable basis to believe the
information can be used to identify the individual.
Plan Administration Functions means administration functions performed by the Plan
Sponsor on behalf of the Plan, excluding functions performed by the Plan Sponsor in
connection with any other benefit or benefit plan of the Plan Sponsor.
Plan Participation means that the enrollee has agreed to accept the benefits offered by
the employer group plan. To illustrate, if an enrollee is eligible for benefits under both
his or her plan and also under a spouse's plan, the enrollee may elect not to participate
in his or her own employer's plan, and choose instead to participate in the spouse's
plan.
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Protected Health Information means individually Identifiable Health Information:
(1) Except as provided in paragraph (2) of this definition, that is:
(i) Transmitted by electronic media;
Maintained in any media described in the definition of electronic
media at 42 CFR § 162.103; or
(iii) Transmitted or maintained in any other form or medium.
(2) Protected Health Information excludes Individually Identifiable Health
Information in:
(i) Education records covered by the Family Educational Rights and
Privacy Act, as amended, 20 U.S.C. § 1232g;
(ii) Records described at 20 U.S.C. § 1232g(a)(4)(8)(iv); and
Employment records held by a Covered Entity in its role as
employer.
Summary Health Information means information that (1) summarizes the claims
history, claims expenses or type of claims experienced by individuals for whom a plan
sponsor had provided health benefits under a Health Plan; and (2) from which the
information described at 42 CFR § 164.514(b)(2)(i) has been deleted, except that the
geographic information described in 42 CFR § 164.514(b)(2)(i)(B) need only be
aggregated to the level of a five -digit zip code.
Transaction means the transmission of information between two parties to carry out
financial or administrative activities related to health care.
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PLAN SPONSOR CERTIFICATION
OF AMENDMENT TO PLAN
City of Fort Collins, Colorado
The City of Fort Collins, Colorado ("Plan Sponsor") is the sponsor of the
Professional Services Agreement, as amended, between the Plan Sponsor and
Employee Assistance Programs International, Inc., a subsidiary of Horizon Behavioral
Services, Inc. (the "Group Health Plan,"). Plan Sponsor performs plan administration
functions for Group Health Plan and needs access to the Group Health Plan
participants' PHI to carry out those plan administration functions.
Plan Sponsor hereby certifies that the Plan Document of Group Health Plan has
been amended to comply with the requirements of 45 Code of Federal Regulations
§ 164.504(f)(2). The amendment provides the required assurance that Plan Sponsor
will appropriately safeguard and limit the use and disclosure of the Group Health Plan
participants' PHI that Plan Sponsor may receive from Employee Assistance Programs
International, Inc., a subsidiary of Horizon Behavioral Services, Inc., to perform plan
administration functions.
Accordingly, Employee Assistance Programs International, Inc., a subsidiary of
Horizon Behavioral Services, Inc., may provide to the employees of the Plan Sponsor
designated in the amendment to the Plan Document (or hereafter designated in writing
by the Plan Sponsor) the minimum necessary PHI of Group Health Plan participants for
Plan Sponsor to perform its plan administration functions for the Group Health Plan.
A o ' ed Signature
James S. O'Neill 11 CPPO
Name
Director of Purchasin and Risk Marra ement
Title
city of Fort Collins
Plan Sponsor
AMU 1 2003
Date