HomeMy WebLinkAboutAgreement A-23-174 Amendment to agreement with DHCS - Executed.pdf PzA,oHCS
CALIFORNIA DEPARTMENT OF
HEALTH CARE SERVICES
Michelle Baass I Director
May 2, 2023
Qiaj Vang
Fresno County
Department of Social Services
205 W. Pontiac Way, Building 2
Clovis, CA, 93612
Dear Sir or Madam:
Enclosed is the fully executed Amendment to the 2019 Medi-Cal Privacy and Security
Agreement (Amendment) between the Department of Health Care Services (DHCS)
and Fresno County. Two original versions of the Agreement were submitted by Fresno
County. DHCS is returning one original Agreement(s) to Fresno County and will retain
the other for DHCS' files.
If you have any questions, or if we can provide further information, please contact the
DHCS PSA community inbox at CountyPSA((_dhcs.ca.gov.
Sincerely,
Sarah Linder, Section Chief
Program and Administrative Systems Section
Program Operations Branch
Medi-Cal Eligibility Division
Enclosure
California Department of Health Care Services State of California '�`
Medi-Cal Eligibility Division Gavin Newsom, Governor
1501 Capitol Avenue I Sacramento,CA 1 95899-7413
MS 4607 1 Phone (916) 552-9200 1 www.dhcs.ca.gov California Health and Human Services Agency
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Department of Social Services
Sanja Bugay, Director
O 1556 O
;A� FRESH
DATE: April 14, 2023
TO: Department of Health Care Services
.FROM: Qiaj Vang, Staff Analyst, Fresno County Department of Social Services
RE: Amendment for 2019 Medi-Cal Privacy and Security Agreement
Included in this mail is the Amendment for 2019 Medi-Cal Privacy and Security
Agreement for DHCS signature.
Per submission guidelines, below is the contact information for returning the signed Amendments.
Qiaj Vang
Fresno County Department of Social Services
205 W. Pontiac Way, Building 2
Clovis, CA 93612
Phone: (559) 600-4093
Email: gvang@fresnocountyca.gov
Information: (559)600-2300 ♦ 205 W. Pontiac Way—Clovis, CA 93612
www.co.fresno.ca.us
The County of Fresno is an Equal Employment Opportunity Employer
Agreement No.23-174
MEDI-CAL PRIVACY& SECURITY AGREEMENT NO.: 19-m -A01
AMENDMENT TO THE
MEDI-CAL PRIVACY AND SECURITY AGREEMENT (Agreement)
BETWEEN
the California Department of Health Care Services (DHCS) and the
County of Fresno
Department/Agency of Social Services ;
1,0�,
parties to the Agreement#19-429 , effective on September 1, 2019.
This Amendment entered into by and between the
County of Fresno
Department/Agency of Social Services
(County Department/Agency) and DHCS, extends the termination date of the
Agreement to allow ongoing transmissions of Medi-Cal PII while the renewal of the
Agreement is negotiated and finalized between DHCS and the County
Departments/Agencies.
AGREEMENTS
DHCS and County Department/Agency mutually agree to modify the following parts of
the Agreement as set forth below:
XVIII. TERMINATION
A. The Agreement shall terminate on either March 1, 2024 or upon execution of a
successor 2022 PSA, whichever occurs first. The parties can agree in writing to
extend the term of the Agreement. County Department/Agency requests for an
extension shall be approved by DHCS and limited to no more than a six (6)
month extension.
B. Survival: All provisions of the Agreement that provide restrictions on disclosures
of Medi-Cal PII and that provide administrative, technical, and physical
safeguards for the Medi-Cal PI in the County Department/Agency's possession
shall continue in effect beyond the termination or expiration of the Agreement,
and shall continue until the Medi-Cal PII is destroyed or returned to DHCS.
Except as set forth in this Amendment, the Agreement is unaffected and shall continue
in full force and effect in accordance with its terms. If there is conflict between this
Amendment and the Agreement, the terms of this Amendment will prevail.
1
MEDI-CAL PRIVACY& SECURITY AGREEMENT NO.: 19-a-A01
SIGNATORIES
The signatories below warrant and represent that they have the competent authority on
behalf of their respective agencies to enter into the obligations set forth in this
Amendment.
The authorized officials whose signature appears below have bound their respective
agencies to the terms of the Agreement, as modified by this Amendment.
For the County of Fresno
Department/Agency of Social Services
r
r'11 1 I ,2L 7 3
(Si a r (Date)
Sal Quintero Chairman of the Board
(Name) (Title) ATTEST:
BERNICE E.SEIDEL
Clerk of the Board of Supervisors
County of Fresno,State of California
By /�t0lrrwa
For the Department of Health Care Services, Deputy
-- -L 3
(S i g nffi re)/ �; (Date)
(N me)J4 (Title)
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