HomeMy WebLinkAboutAgreement A-06-072-2 with Blue Cross.pdf- 1 -
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SECOND AMENDMENT TO AGREEMENT
THIS SECOND AMENDMENT TO AGREEMENT (hereinafter “Amendment”) is made and
entered into this _____ day of ______________, 2020, by and between COUNTY OF FRESNO, a
Political Subdivision of the State of California, Fresno, California (hereinafter “COUNTY”), and Blue
Cross of California, a California corporation, whose address is 21555 Oxnard Street, Woodland Hills,
CA 91367 (hereinafter “CONTRACTOR”).
WITNESSETH:
WHEREAS, COUNTY and CONTRACTOR entered into Agreement number A-06-072, dated
May 1, 2006, and Amendment I (Agreement number A-06-072-01) to that Agreement, dated May 16,
2017 (collectively hereinafter “Agreement”), pursuant to which CONTRACTOR agreed to collaborate
and cooperate with COUNTY in providing public health services; and
WHEREAS, COUNTY and CONTRACTOR wish to amend the Agreement to include a Health
Insurance Portability and Accountability Act (HIPAA) Business Associate agreement to protect the
privacy and provide for the security of Protected Health Information (PHI) disclosed by COUNTY to
CONTRACTOR during the term of this Agreement; and
WHEREAS, COUNTY and CONTRACTOR now desire to amend the Agreement regarding
changes as stated below.
NOW, THEREFORE, for good and valuable consideration, the receipt and adequacy of which
is hereby acknowledged, COUNTY and CONTRACTOR agree as follows:
1.COUNTY and CONTRACT agree to the terms of the HIPAA Business Associate
Agreement, attached hereto as Exhibit G, and agree that Exhibit G shall become a part of, and be
incorporated into, the Agreement.
COUNTY and CONTRACTOR agree that this Second Amendment is sufficient to amend the
Agreement and, that upon execution of this Second Amendment, the Agreement, Amendment I and
this Second Amendment together shall be considered the Agreement.
The Agreement, as hereby amended, is ratified and continued. All provisions, terms,
covenants, conditions and promises contained in the Agreement and not amended herein shall remain
in full force and effect.
Agreement No. 06-072-2
24th November
1 IN WITNESS WHEREOF, the parties hereto have executed this Second Amendment as of the
2 day and year first hereinabove written .
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4 CONTRACTOR
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7 (Authorized Signature)
8 Barsam Kasravi , MD
Print Name & Title
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President-Medicaid CA
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barsam.kasravi@anthem .com
11 Mailing Address
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FOR ACCOUNTING USE ONLY : 24
25 Fund/Subclass : 0001/10000
Org :56208550
26 Account: 7309
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COUNTY OF FRESNO
Ernest Buddy Mende , Chairman of the
Board of Supervisors of the County of
Fresno
ATTEST:
Bernice E. Seidel
Clerk of the Board of Supervisors
County of Fresno , State of California
By : _ ____...._d.....:' ~=·=-· l --=~~~---~
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EXHIBIT G
HIPAA BUSINESS ASSOCIATE AGREEMENT
This Exhibit, the HIPAA Business Associate Agreement (“Exhibit”) supplements and is made a part
of the underlying agreement (“Agreement”) by and between the County of Fresno, (“County” or
“Covered Entity”) and Blue Cross of California Partnership Health Plan, Inc, (“Contractor” or
“Business Associate”) to which this Exhibit is attached. This Exhibit is effective upon execution of
the Second Amendment to the Agreement.
I.RECITALS
Covered Entity wishes to disclose certain information to Business Associate pursuant to the terms of
the Agreement, some of which may constitute Protected Health Information (“PHI”); Covered Entity
and Business Associate intend to protect the privacy and provide for the security of PHI disclosed to
Business Associate pursuant to the Agreement in compliance with the Health Insurance Portability
and Accountability Act of 1996, Public Law 104-191 (“HIPAA”), the Health Information
Technology for Economic and Clinical Health Act, Public Law 111-005 (the “HITECH Act”), the
regulations promulgated thereunder by the U.S. Department of Health and Human Services (the
“HIPAA Regulations”), and other applicable laws; and The Privacy Rule and the Security Rule in the
HIPAA Regulations require Covered Entity to enter into a contract, containing specific requirements,
with Business Associate prior to the disclosure of PHI, as set forth in, but not limited to, Title 45,
sections 164.314(a), 164.502(e), and 164.504(e) of the Code of Federal Regulations (“C.F.R.”) and as
contained in this Agreement.
II.STANDARD DEFINITIONS
Capitalized terms used, but not otherwise defined, in this Exhibit shall have the same meaning as
those terms are defined in the HIPAA Regulations. In the event of an inconsistency between the
provisions of this Exhibit and the mandatory provisions of the HIPAA Regulations, as amended, the
HIPAA Regulations shall control. Where provisions of this Exhibit are different than those mandated
in the HIPAA Regulations, but are nonetheless permitted by the HIPAA Regulations, the provisions
of this Exhibit shall control. All regulatory references in this Exhibit are to HIPAA Regulations
unless otherwise specified.
The following terms used in this Exhibit shall have the same meaning as those terms in the HIPAA
Regulations: Data Aggregation, Designated Record Set, Disclosure, Electronic Health Record, Health
Care Operations, Health Plan, Individual, Limited Data Set, Marketing, Minimum Necessary,
Minimum Necessary Rule, Protected Health Information, and Security Incident.
The following term used in this Exhibit shall have the same meaning as that term in the HITECH
Act: Unsecured PHI.
III.SPECIFIC DEFINITIONS
Agreement. “Agreement” shall mean the underlying agreement between County and Contractor, to
which this Exhibit, the HIPAA Business Associate Agreement, is attached.
Business Associate. “Business Associate” shall generally have the same meaning as the term
“business associate” at 45 C.F.R. section 160.103, the HIPAA Regulations, and the HITECH Act,
and in reference to a party to this Exhibit shall mean the Contractor identified above. “Business
Associate” shall also mean any subcontractor that creates, receives, maintains, or transmits PHI in
performing a function, activity, or service delegated by Contractor.
Contractual Breach. “Contractual Breach” shall mean a violation of the contractual obligations set
forth in this Exhibit.
Covered Entity. “Covered Entity” shall generally have the same meaning as the term “covered entity”
at 45 C.F.R. section 160.103, and in reference to the party to this Exhibit, shall mean any part of
County subject to the HIPAA Regulations.
Electronic Protected Health Information. “Electronic Protected Health Information” or “Electronic
PHI” means Protected Health Information that is maintained in or transmitted by electronic media.
Exhibit. “Exhibit” shall mean this HIPAA Business Associate Agreement.
HIPAA. “HIPAA” shall mean the Health Insurance Portability and Accountability Act of 1996,
Public Law 104-191.
HIPAA Breach. “HIPAA Breach” shall mean a breach of Protected Health Information as defined in
45 C.F.R. 164.402, and includes the unauthorized acquisition, access, use, or Disclosure of Protected
Health Information which compromises the security or privacy of such information.
HIPAA Regulations. “HIPAA Regulations” shall mean the regulations promulgated under HIPAA by
the U.S. Department of Health and Human Services, including those set forth at 45 C.F.R. Parts 160
and 164, Subparts A, C, and E.
HITECH Act. “HITECH Act” shall mean the Health Information Technology for Economic and
Clinical Health Act, Public Law 111-005 (the “HITECH Act”).
Privacy Rule and Privacy Regulations. “Privacy Rule” and “Privacy Regulations” shall mean the
standards for privacy of individually identifiable health information set forth in the HIPAA
Regulations at 45 C.F.R. Part 160 and Part 164, Subparts A and E.
Secretary. “Secretary” shall mean the Secretary of the United States Department of Health and
Human Services (“DHHS”) or his or her designee.
Security Rule and Security Regulations. “Security Rule” and “Security Regulations” shall mean the
standards for security of Electronic PHI set forth in the HIPAA Regulations at 45 C.F.R. Parts 160
and 164, Subparts A and C.
IV.PERMITTED USES AND DISCLOSURES OF PHI BY BUSINESS ASSOCIATE
Business Associate may only use or disclose PHI:
A.As necessary to perform functions, activities, or services for, or on behalf of, Covered Entity as
specified in the Agreement, provided that such use or Disclosure would not violate the Privacy
Rule if done by Covered Entity;
B.As required by law; and
C.For the proper management and administration of Business Associate or to carry out the legal
responsibilities of Business Associate, provided the disclosures are required by law, or Business
Associate obtains reasonable assurances from the person to whom the information is disclosed that
the information will remain 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 notifies Business
Associate of any instances of which it is aware in which the confidentiality of the information has
been breached.
V.PROTECTION OF PHI BY BUSINESS ASSOCIATE
A.Scope of Exhibit. Business Associate acknowledges and agrees that all PHI that is created or
received by Covered Entity and disclosed or made available in any form, including paper record,
oral communication, audio recording and electronic display, by Covered Entity or its operating
units to Business Associate, or is created or received by Business Associate on Covered Entity’s
behalf, shall be subject to this Exhibit.
B.PHI Disclosure Limits. Business Associate agrees to not use or further disclose PHI other than
as permitted or required by the HIPAA Regulations, this Exhibit, or as required by law.
Business Associate may not use or disclose PHI in a manner that would violate the HIPAA
Regulations if done by Covered Entity.
C.Minimum Necessary Rule. When the HIPAA Privacy Rule requires application of the Minimum
Necessary Rule, Business Associate agrees to use, disclose, or request only the Limited Data
Set, or if that is inadequate, the minimum PHI necessary to accomplish the intended purpose of
that use, Disclosure, or request. Business Associate agrees to make uses, Disclosures, and
requests for PHI consistent with any of Covered Entity’s existing Minimum Necessary policies
and procedures.
D.HIPAA Security Rule. Business Associate agrees to use appropriate administrative, physical and
technical safeguards, and comply with the Security Rule and HIPAA Security Regulations with
respect to Electronic PHI, to prevent the use or Disclosure of the PHI other than as provided for by
this Exhibit.
E.Mitigation. Business Associate agrees to mitigate, to the extent practicable, any harmful effect that
is known to Business Associate of a use or Disclosure of PHI by Business Associate in violation
of the requirements of this Exhibit. Mitigation includes, but is not limited to, the taking of
reasonable steps to ensure that the actions or omissions of employees or agents of Business
Associate do not cause Business Associate to commit a Contractual Breach.
F.Notification of Breach. During the term of the Agreement, Business Associate shall notify
Covered Entity in writing within twenty-four (24) hours of any suspected or actual breach of
security, intrusion, HIPAA Breach, and/or any actual or suspected use or Disclosure of data in
violation of any applicable federal or state laws or regulations. This duty includes the reporting
of any Security Incident, of which it becomes aware, affecting the Electronic PHI. Business
Associate shall take (i) prompt corrective action to cure any such deficiencies and (ii) any action
pertaining to such unauthorized use or Disclosure required by applicable federal and/or state
laws and regulations. Business Associate shall investigate such breach of security, intrusion,
and/or HIPAA Breach, and provide a written report of the investigation to Covered Entity’s
HIPAA Privacy Officer or other designee that is in compliance with 45 C.F.R. section 164.410
and that includes the identification of each individual whose PHI has been breached. The report
shall be delivered within fifteen (15) working days of the discovery of the breach or
unauthorized use or Disclosure. Business Associate shall be responsible for any obligations
under the HIPAA Regulations to notify individuals of such breach, unless Covered Entity
agrees otherwise.
G.Agents and Subcontractors. Business Associate agrees to ensure that any agent, including a
subcontractor, to whom it provides PHI received from, or created or received by Business
Associate on behalf of Covered Entity, agrees to the same restrictions, conditions, and
requirements that apply through this Exhibit to Business Associate with respect to such
information. Business Associate shall obtain written contracts agreeing to such terms from all
agents and subcontractors. Any subcontractor who contracts for another company’s services with
regards to the PHI shall likewise obtain written contracts agreeing to such terms. Neither Business
Associate nor any of its subcontractors may subcontract with respect to this Exhibit without the
advanced written consent of Covered Entity.
H.Review of Records. Business Associate agrees to make internal practices, books, and records
relating to the use and Disclosure of PHI received from, or created or received by Business
Associate on behalf of Covered Entity available to Covered Entity, or at the request of Covered
Entity to the Secretary, in a time and manner designated by Covered Entity or the Secretary, for
purposes of the Secretary determining Covered Entity’s compliance with the HIPAA Regulations.
Business Associate agrees to make copies of its HIPAA training records and HIPAA business
associate agreements with agents and subcontractors available to Covered Entity at the request of
Covered Entity.
I.Performing Covered Entity’s HIPAA Obligations. To the extent Business Associate is required to
carry out one or more of Covered Entity’s obligations under the HIPAA Regulations, Business
Associate must comply with the requirements of the HIPAA Regulations that apply to Covered
Entity in the performance of such obligations.
J.Restricted Use of PHI for Marketing Purposes. Business Associate shall not use or disclose PHI
for fundraising or Marketing purposes unless Business Associate obtains an Individual’s
authorization. Business Associate agrees to comply with all rules governing Marketing
communications as set forth in HIPAA Regulations and the HITECH Act, including, but not
limited to, 45 C.F.R. section 164.508 and 42 U.S.C. section 17936.
K.Restricted Sale of PHI. Business Associate shall not directly or indirectly receive remuneration
in exchange for PHI, except with the prior written consent of Covered Entity and as permitted by
the HITECH Act, 42 U.S.C. section 17935(d)(2); however, this prohibition shall not affect
payment by Covered Entity to Business Associate for services provided pursuant to the
Agreement.
L.De-Identification of PHI. Unless otherwise agreed to in writing by both parties, Business
Associate and its agents shall not have the right to de-identify the PHI. Any such de-
identification shall be in compliance with 45 C.F.R. sections 164.502(d) and 164.514(a) and (b).
M.Material Contractual Breach. Business Associate understands and agrees that, in accordance
with the HITECH Act and the HIPAA Regulations, it will be held to the same standards as
Covered Entity to rectify a pattern of activity or practice that constitutes a material Contractual
Breach or violation of the HIPAA Regulations. Business Associate further understands and
agrees that: (i) it will also be subject to the same penalties as a Covered Entity for any violation
of the HIPAA Regulations, and (ii) it will be subject to periodic audits by the Secretary.
VI.INDIVIDUAL CONTROL OVER PHI
A.Individual Access to PHI. Business Associate agrees to make available PHI in a Designated
Record Set to an Individual or Individual’s designee, as necessary to satisfy Covered Entity’s
obligations under 45 C.F.R. section 164.524. Business Associate shall do so solely by way of
coordination with Covered Entity, and in the time and manner designated by Covered Entity.
B.Accounting of Disclosures. Business Associate agrees to maintain and make available the
information required to provide an accounting of Disclosures to an Individual as necessary to
satisfy Covered Entity’s obligations under 45 C.F.R. section 164.528. Business Associate shall do
so solely by way of coordination with Covered Entity, and in the time and manner designated by
Covered Entity.
C.Amendment to PHI. Business Associate agrees to make any amendment(s) to PHI in a Designated
Record Set as directed or agreed to by Covered Entity pursuant to 45 C.F.R. section 164.526, or
take other measures as necessary to satisfy Covered Entity’s obligations under 45 C.F.R. section
164.526. Business Associate shall do so solely by way of coordination with Covered Entity, and
in the time and manner designated by Covered Entity.
VII.TERMINATION
A.Termination for Cause. A Contractual Breach by Business Associate of any provision of this
Exhibit, as determined by Covered Entity in its sole discretion, shall constitute a material
Contractual Breach of the Agreement and shall provide grounds for immediate termination of
the Agreement, any provision in the Agreement to the contrary notwithstanding. Contracts
between Business Associates and subcontractors are subject to the same requirement for
Termination for Cause.
B.Termination due to Criminal Proceedings or Statutory Violations. Covered Entity may terminate
the Agreement, effective immediately, if (i) Business Associate is named as a defendant in a
criminal proceeding for a violation of HIPAA, the HITECH Act, the HIPAA Regulations or
other security or privacy laws or (ii) a finding or stipulation that Business Associate has violated
any standard or requirement of HIPAA, the HITECH Act, the HIPAA Regulations or other
security or privacy laws is made in any administrative or civil proceeding in which Business
Associate has been joined.
C.Return or Destruction of PHI. In the event of termination for any reason, or upon the expiration of
the Agreement, Business Associate shall return or, if agreed upon by Covered Entity, destroy all
PHI received from Covered Entity, or created or received by Business Associate on behalf of
Covered Entity. Business Associate shall retain no copies of the PHI. This provision shall apply to
PHI that is in the possession of subcontractors or agents of Business Associate.
If Business Associate determines that returning or destroying the PHI is infeasible under this
section, Business Associate shall notify Covered Entity of the conditions making return or
destruction infeasible. Upon mutual agreement of the parties that return or destruction of PHI is
infeasible, Business Associate shall extend the protections of this Exhibit to such PHI and limit
further uses and Disclosures to those purposes that make the return or destruction of the
information infeasible.
VIII.MISCELLANEOUS
A.Disclaimer. Covered Entity makes no warranty or representation that compliance by Business
Associate with this Exhibit, HIPAA, the HIPAA Regulations, or the HITECH Act will be
adequate or satisfactory for Business Associate’s own purposes or that any information in
Business Associate’s possession or control, or transmitted or received by Business Associate is
or will be secure from unauthorized use or Disclosure. Business Associate is solely responsible
for all decisions made by Business Associate regarding the safeguarding of PHI.
B.Regulatory References. A reference in this Exhibit to a section in HIPAA, the HIPAA
Regulations, or the HITECH Act means the section as in effect or as amended, and for which
compliance is required.
C.Amendments. The parties agree to take such action as is necessary to amend this Exhibit from
time to time as is necessary for Covered Entity to comply with the requirements of HIPAA, the
HIPAA Regulations, and the HITECH Act.
D.Survival. The respective rights and obligations of Business Associate with respect to PHI in the
event of termination, cancellation or expiration of this Exhibit shall survive said termination,
cancellation or expiration, and shall continue to bind Business Associate, its agents, employees,
contractors and successors.
E.No Third Party Beneficiaries. Except as expressly provided herein or expressly stated in the
HIPAA Regulations, the parties to this Exhibit do not intend to create any rights in any third
parties.
F.Governing Law. The provisions of this Exhibit are intended to establish the minimum
requirements regarding Business Associate’s use and Disclosure of PHI under HIPAA, the
HIPAA Regulations and the HITECH Act. The use and Disclosure of individually identified
health information is also covered by applicable California law, including but not limited to the
Confidentiality of Medical Information Act (California Civil Code section 56 et seq.). To the
extent that California law is more stringent with respect to the protection of such information,
applicable California law shall govern Business Associate’s use and Disclosure of confidential
information related to the performance of this Exhibit.
G.Interpretation. Any ambiguity in this Exhibit shall be resolved in favor of a meaning that
permits Covered Entity to comply with HIPAA, the HIPAA Regulations, the HITECH Act, and
in favor of the protection of PHI.