Resolution No. 8973t
1 RESOLUTION NO. 8973
2
3 A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF
VERNON APPROVING AND RATIFYING THE EXECUTION OF A
4 BUSINESS ASSOCIATE AGREEMENT BY AND BETWEEN THE
CITY OF VERNON AND PART D ADVISORS, INC. RELATING
5 TO MEDICARE PART D IMPLEMENTATION SERVICES
6
7 WHEREAS, on November 16, 2005, the City Council of the City
8 of Vernon adopted Resolution No. 8909 approving the filing of an
9 application for federal subsidies for medicare drug purchases and
10 approving an Agreement for Medicare Part D Implementation Services
11 (the "Services Agreement") with Part D Advisors, Inc. (""Part D"); and
12 WHEREAS, in order for Part D to obtain health claims data in
13 accordance with the Health Insurance Portability and Accountability
14 Act of 1996 and 45 CFR Parts 160-164 (the "Privacy Rule"), Part D has
15 requested that the City enter into a agreement to satisfy the
16 "business associate" and related requirements within the meaning of
17 the Privacy Rule; and
18 WHEREAS, such "business associate" agreement will be a
19 supplemental attachment to the Services Agreement; and
20 WHEREAS, in order to meet the urgent need to facilitate the
21 City's Medicare Part D Program, the Chief Deputy City Attorney/Acting
22 Risk Manager executed a Business Associate Agreement (the "Agreement")
23 with Part D on February 6, 2006, subject to ratification by the City
24 Council.
25 NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE
26 CITY OF VERNON AS FOLLOWS:
27 SECTION 1: The City Council of the City of Vernon hereby
28 finds and determines that the recitals contained hereinabove are true
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and correct.
SECTION 2: The City Council of the City of Vernon hereby
ratifies the execution of the Business Associate Agreement with Part D
executed on February 6, 2006, a copy of which is attached hereto as
Exhibit A and incorporated by reference.
SECTION 3: The Acting City Clerk of the City of Vernon
shall certify to the passage of this resolution, and thereupon and
thereafter the same shall be in full force and effect.
APPROVED AND ADOPTED this 15th day of February, 2006.
(ATTEST:
BRUCE V. MA4KENHORST, JR.
Acting(Cit Clerk
LEONIS C. MA4BURG, Mayor
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STATE OF CALIFORNIA )
) ss
COUNTY OF LOS ANGELES j
I, BRUCE V. MALKENHORST, JR., Acting City Clerk of the City of
Vernon, do hereby certify that the foregoing Resolution, being
Resolution No. 8973, was duly adopted by the City Council of the City
of Vernon at a regular meeting of the City Council duly held on
Wednesday, February 15, 2006, and thereafter was duly signed by the
Mayor of the City of Vernon.
BRUCE V.k4ALKENHORST, JR.
Acting City Clerk
(SEAL)
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EXHIBIT
ATTACHMENT B
Business Associate Agreement
This BUSINESS ASSOCIATE AGREEMENT (this' ") is entered into by and
between Part D Advisors, Inc., a Michigan corporation ("EDA") and The C itv of Vernon. California
Health Plan (the "Health Plan") (together, the "Parties"), effective as provided'' below.
RECITALS
WHEREAS, the Health Plan is a "covered entity" within the meaning of the Health
Insurance Portability and Accountability Act of 1996 Cl�) and its implementing regulation
concerning privacy of individually identifiable health information as set forth in 45 CFR Parts 160-164,
as amended from time to time (the ` 'vacv Rule"); and
WHEREAS, PDA has heretofore entered into an agreement with The City of Vernon,
California ("Plan Sponsor') to provide certain administrative services in connection with the Health Plan
(the "Service Agreement'); and
WHEREAS, the Privacy Rule requires covered entities such as the Health Plan to obtain
and document satisfactory assurances from "business associates" (as defined therein) regarding
appropriate safeguarding of certain "protected health information" (as defined therein) received or created
by the business associate (a "BA Agreement"); and.
WHEREAS, PDA, in the performance of its services in connection with the Health Plan,
may be deemed a "business associate" within the meaning of the Privacy Rule; and
WHEREAS, the Parties desire to enter into an agreement intended to satisfy the BA
Agreement requirement and related requirements under the Part D Program (as defined in the Service
Agreement) as and to the extent such requirement may be applicable.
NOW, THEREFORE, in consideration of the premises and the respective covenants and
agreements herein contained, the Parties agree as follows:
AGREEMENT
I. Definitions
Capitalized terms not expressly detained in this Agreement shall have the meanings
as defined in the Privacy Rule. For purposes of this Agreement:
(a) "Designated Record Set" shall have the same meaning as the term "designated record
set" in 45 CFR 164.501 in respect of the Health Plan.
(b) "Efjerdye Date" shall have the meaning as set forth in Section 7(a) of this Agreement.
(c) "ERISA" shall mean Employee Retirement Income Security Act of 1974, as amended,
and the regulations hereunder.
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(d) `Individual" shall have the same meaning as the term "individual" in 45 CFR 164.501
and shall include a person who qualifies as a personal representative in accordance with 45 CFR
164.502(g).
(e) "Health Plan Administra or" or "Plan Adminlatiwor" shall have the same meaning as
set forth in the Health Plan's Plan Document.
(f) "Privacy Rule" shall have the meaning as set forth in the RECITALS portion of this
Agreement.
(g) "Protected Health Information" shall have the same meaning as the term "protected
health information" in 45 CFR 164.501, but limited to the information crested or received by PDA from
or on behalf of the Health Plan.
(h) "Required by Law" shall have the same meaning as the term "required by law" in 45
CFR 164.5,01 (and as further described in 70 Federal Register 4405 with regard to compliance with the
Center for Medicare and Medicaid Services' requirement of disclosure of Protected Health Information
pursuant to 42 CFR 423.884(b)).
G) "Secretary" shall mean the Secretary of the Department of Health and Human Services
or his designee.
0) "Service Agreement" shall have the meaning as set forth in the RECITALS portion of
this Agreement.
2. Obligations of PDA
PDA agrees to:
(a) Not use or disclose Protected Health Information other than as permitted or required by
this Agreement or as Required By Law,
(b) Use appropriate safeguards to prevent use or disclosure of the Protected Health
Information other than as provided for by this Agreement;
(c) Report to the Health Plan Administrator any use or disclosure of the Protected Health
Information not provided for by this. Agreement of which it becomes aware;
(d) Ensure that any agent, including a subcontractor, to whom it provides Protected Health
Information received from the Health Plan, or created or received by PDA on behalf of the Health Plan
agrees to the same restrictions and conditions that apply through this Agreement to PDA with respect to
such information; provided that the Health Plan shall not have any right to disapprove any subcontractors
of PDA or to review any agreements with such subcontractors, except to the extent specifically provided
herein;
(e) Provide, in a commercially reasonable time and manner, access to Protected Health
Information to the Health Plan Administrator to the extent necessary to meet the requirements under 45
CFR 164.524, provided that such access shall be provided only to the extent such Protected Health
Information is in the possession of PDA and is a part of the Designated Record Set.
(f) Make, in a commercially reasonable time and manner, any amendment(s) to Protected
.Health Information that the Health Plan Administrator directs or agrees to pursuant to 45 CFR 164.526,
BA K 0 2 7/29/05
provided that such amendment(s) shall be made only to the extent such Protected Health Information is in
the possession of PDA and is a part of the Designated Record Set;
(g) bake .available to the Health Plan, in a commercially reasonable time and manner,
information in the possession of PDA as and to the extent required for the Health Plan to respond to a
request by an Individual for an accounting of disclosures of Protected Health Information in accordance
with 45 CFR 164.528;
(h) Make internal practices, books, and records relating to the use and disclosure of Protected
Health information received from the Health Plan, or created or received by PDA on behalf of the Health
Plan, available to the Secretary for purposes of the Secretary determining the Health Plan's compliance
with the Privacy Rule.
3. Permitted Uses and Disclosures by PDA
(a) Cleneral Use and DWOAM Provisions. Except as otherwise limited in this Agreement,
PDA may use or disclose Protected Health Information to perform its duties, functions, activities, or
services for, or on behalf of, the Health Plan or its Plan Sponsor, provided that such use or disclosure
would not violate (i) the Privacy Rule if done by the Health Plan or (ii) the minimum necessary policies
and procedures of the Health Plan as communicated by the Health Plan Administrator to PDA.
(b) SRmific Use and Disclosure Provisions.
(i) PDA may use Protected Health Information for the proper
management and administration of PDA or to carry out the legal responsibilities
of PDA.
GO Except as otherwise limited in this Agreement, PDA may disclose Protected
Health Information for the proper management and administration of PDA or to.
carry out the legal responsibilities of PDA, provided that:
(A) Disclosures are Required By Law, or
(B) PDA obtains reasonable assurances from the person to whom the
information is disclosed that it will be held confidentially and used or
further disclosed only as Required By Law or for the purpose for which
it was disclosed to the person, and the 'person notifies PDA of any
instances of which it is aware in which the confidentiality of the
information has been breached.
(iii) Except as otherwise limited in this Agreement, PDA may use Protected Health
Information to provide Data Aggregation services as permitted by 45 CFR
164.504(ex2)(i)(B).
(iv) PDA may use or disclose Protected Health Information to report violations of law
to appropriate Federal and/or State authorities to the extent consistent with 45
CFR 164.5020).
(v) Except as otherwise limited in this Agreement, PDA may disclose Protected
Health Information to other "business associates" (within the meaning of the
Privacy Rule) of the Health Plan to perform its dudes under the Service
Agreement. Notwithstanding any provision hereof or any other prior agreement
by the Parties, it shall be the Health Plan's sole responsibility (and not PDA's
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responsibility) to ensure that the Health Plan has entered into appropriate
business associate agreements with its business associates.
(vi) Except as otherwise limited in this Agreement, PDA may disclose Protected
Health Information to the persons to whom the Hesalth Plan Administrator directs
PDA to provide Protected Health Information. Notwithstanding any provision
hereof or any other prior agreement by the Parties, it shall be the Health Plan's
sole responsibility (and not PDA's responsibility) to ensure that the Health Plan
has, in its official plan document, appropriate provisions regarding disclosures of
Protected Health Information.
4. Obligations of the Health Ptah and Health Plan Admiuistraetor
(a) General. Except as otherwise specifically provided under this Agreement, the Health Plan
shall not request or permit PDA to (and shall not cause the Health Plan Administrator to request or permit
PDA to) use or disclose Protected Health Information in any manner that may not be permissible under
the Privacy Rule if done by the Health Plan.
(b) Notification of Privacy Practices and Restrictions: The Health Plan shall cause the Health
Plan Administrator to promptly notify PDA of
(i) Any limitation(s) in the Health Plan's notice of privacy practices in accordance
with 45 CFR 164.520, to the extent that such limitation may affect PDA's use or
disclosure of Protected Health Information;
(ii) Any changes in, or revocation of, permission by Individual to use or disclosure of
Protected Health Information, to the extent that such changes may affect PDA's
use or disclosure of Protected Health Information; and
(iii) Any restriction to the use or disclosure of Protected Health Information that the
Health Plan has agreed to in accordance with 45 CFR 164.522, to the extent that
such restriction may affect PDA's use or disclosure of Protected Health
Information.
S. Disclosure to CMS for Part D Program
Pursuant to 42 CFR 423.884(b) and notwithstanding any provision herein to the contrary, the
Health Plan agrees that the Health Plan, the Health Plan Administrator or PDA (on behalf of the Health
Plan) may disclose Protected Health Information to the Center for Medicare and Medicaid Services
(CMS) to the extent necessary to comply with Subpart R of 42 CFR Part 423 (relating to Notices of
Creditable and Non -Creditable Coverage and applications for drug subsidy payment to the Plan Sponsor
in connection with the prescription drug benefit under the Health Plan).
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& Security of Electronic Protected Health Information
(a) PDA has implemented administrative, physical, and technical safeguards that
reasonably and appropriately protect the confidentiality, integrity and availability of the
electronic protected health information that it creates, receives or transmits on behalf of the
Health Plan C'ePHI") as required under the Security Standards 45 C.F.R. Part 160 and 164
subpart C.
(b) PDA agrees that it will ensure that agents or subcontractors to whom it provides
ePHI agree to implement the reasonable and appropriate safeguards to protect its confidentiality,
integrity and availability.
(c) PDA agrees to report to the Health Plan any Security Incident (as defined in 45
C.F.R. Part 164.304) within one business day after it becomes aware of any such Security
Incident.
(d) The Health Plan agrees and understands that the Health Plan is independently responsible
for the security of ePHI in its possession, whether it was created by the Health Plan or received from
outside sources (including PDA).
7. Term and Termination
(a) Term. The term of this Agreement shall be for a period commencing as of the effective
date of the Service Agreement and ending when all of the Protected Health Information provided by the
Health Plan to PDA, or created or received by PDA on behalf of the Health Plan, is destroyed, returned to
the Health Plan or further protected in accordance with the termination provisions in this Section 7.
(b) Termination for Cause. Upon the Health Plan Administrator's knowledge of a Significant
Breach of PDA's obligation under this Agreement and subject to Section 7(e) hereof, the Health Plan
Administrator may commence termination of this Agreement by providing a notice of termination to
PDA. Notwithstanding the foregoing, this Agreement shall be considered to have been terminated
pursuant to this Section 7(b) only if, prior to such notice of termination:
(i) The Health Plan Administrator shall have given to PDA written notice
describing with specificity the Significant Breach;
(ii) A period of 60 days from and after the giving of such notice shall have
elapsed without PDA Is having cured or remedied such reason for termination during such
60-day period; and
(iii) A final determination shall have been made by the Health Plan
Administrator that Significant Breach persists, following a meeting at which PDA shall
be entitled to appear and contest the determination.
(c) edition Precedent. Upon receipt of a notice of termination pursuant to Section 7(b)
hereof, or for termination of this Agreement for any other reason, PDA shall ret4m all Protected Health
Information received from the Health Plan, or created or received by PDA on behalf of the Health Plan,
that PDA still maintains in any form, and shall retain no copies of such information. If PDA determines
that such return is not feasible, PDA shall extend the protections of this Agreement to such Protected
Health Information and limit further uses and disclosures of such Protected Health Information to those
purposes that make the return or destruction infeasible.
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(d) Reuort to See INN o�, If, in the reasonable determination of the Health Plan
Administrator, termination of the Agreement pursuant to Section 7(b) hereof is not feasible, the Health
Plan Administrator shall report the Significant Breach to the Secretary.
8. Other Provisions
(a) Seoamte from S : Aar---t. Except to the extent specifically provided herein, this
Agreement shall not be construed, and is not intended, to be a part of the Service Agreement or to
otherwise impose on PDA any duties, responsibilities, obligation whatsoever in respect of the
administration of the Health Plan, including any duties, responsibilities or obligation of the Health Plan
pursuant to the Privacy Rule.
(b) No Liability. To the fullest extent permitted by law, PDA shall be under no liability for
any use or disclosure made in accordance with the directions of the Health Plan.
(c) No Duty to Question. Notwithstanding anything herein to the contrary, PDA shall not be
under any duty to question any directions received from the Health Plan Administrator, nor to review in
any respect the manner in which any fiduciary of the Health Plan exercises its authority and discharges its
duties with respect to the Health Plan.
(d) Amendment. The Parties agree to take such action to amend this Agreement from time to
time as is necessary for the Health Plan to comply with the requirements of the Privacy Rule.
(e) Ambi uR it'"- Any ambiguity in this Agreement shall be resolved in a manner that is
consistent with the applicable requirements under the privacy Rule.
(i) Notice. Any notice required to be given hereunder shall be in writing and delivered by
hand or sent by facsimile, registered or certified mail, return receipt requested, or by air courier, to the
address (or fax number) cited in the signature block of this Agreement or to such other address (or fax
number) as shall be specified by like to notice by either Party, and shall be deemed given only when
received
(g) Headings-. The title, headings, and subheadings of this Agreement are solely for the
convenience of the Parties and do not effect the meaning or interpretation of any provision of this
Agreement.
(h) Governnmg Law. Except to the extent preempted by ERISA, this Agreement shall be
governed by and enforceable in accordance with the laws of the State of California without giving effect
to the principles of conflict of laws thereof.
W Arbitration. The parties agree that any and all disputes arising out of or in relation
to this Agreement, including without limitation any action in tort, shall be resolved exclusively,
finally and conclusively by arbitration in Los Angeles County, California under the auspices of
and pursuant to the rules of the Judicial Arbitration & Mediation Services Inc. (JAMS). Each
party will select an arbitrator. Those two arbitrators will then select a third'. The three member
panel will make the final decision. All decisions of the arbitrators shall be in writing, and the
arbitrators shall provide written reasons for their decision. The arbitration decision shall be final
and binding on the parties. Notwithstanding the foregoing, the parties shall, be permitted to
access the court system to enforce any arbitration award or to obtain injunctive relief. The
exclusive jurisdiction and venue for any such action shall be the Superior Court of California,
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Los Angeles County. Any and all contracts between PDA and any subcontractor shall include
the same arbitration clause.
0) EntireASEOWUNIt Tltis Agreement and the Service Agreement contain the entire
understanding between the Healfit Platt and PDA with respect to the subject matter hereof and, except as
specifically Provided herein, cancels and alPerSeda any and all other agreements between the Health
Plan and PDA with respect to the subject matter hereof. Any amendment or modification of this
Agreement shall not be binding unless in writing and signed by both the Health Plan and PDA.
W Severabil tv. In the event that any provision of this Agreement is determined to be invalid
or unenforceable, the remaining terns and conditions of this Agreement shall be unaffected and shall
remain in full force and effect, and any such determination of invalidity or unenforceability shall not
affect the validity or enforceability of any other provision of this Agreement.
. (1) No Benefit to tom. nne representations, covenants and agreements contained in this
Agreement are for the sole benefit of the Parties, and they shall not be construed as conferring, and are
not intended to confer, any rights on any other persons.
(m) QW art . This Agreement may be signed in counterparts, each of which shall be an
original, with the same effect as if the signatures thereto and hereto were upon the same instrument.
IN WITNESS WHEREOF, the Parties have entered into this . Business Associate Agreement,
effective as of the Effective Date.
HEALTH PLAN
Date: �" " By:
Date:
Title: C
Address:
Vernon, CA 9UU5U
tto
Fax Number: _ (g23) g 6_.i439
PARTI) ADVISORS, INC.
By.
Name:
Title:
Address:
Fax Number:
Risk Manager
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AcknOwledgement by Plan Sponsor CITY OF VERNON
By: ,
Name: Willard G Y
Title: uy_City ACCorney Acting Risk Manager
Date: fi
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SUPPORTING
DOCUMENTS
ATTACHMENT B
Business Associate Agreement
This BUSINESS ASSOCIATE AGREEMENT (this "Astreement") is entered into by and
between Part D Advisors, Inc., a Michigan corporation ("PDA') and The City of Vernon, California
Health Plan (the "Health Plan") (together, the "Parties"), effective as provided below.
RECITALS
WHEREAS, the Health Plan is a `covered entity" within the meaning of the Health
Insurance Portability and Accountability Act of 1996 ("HIPAA") and its implementing regulation
concerning privacy of individually identifiable health information as set forth in 45 CFR Parts 160-164,
as amended from time to time (the "Privacy Rule'); and
WHEREAS, PDA has heretofore entered into an agreement with The City of Vernon,
California ("Plan Sponsor") to provide certain administrative services in connection with the Health Plan
(the "Service Agreement'); and
WHEREAS, the Privacy Rule requires covered entities such as the Health Plan to obtain
and document satisfactory assurances from "business associates" (as defined therein) regarding
appropriate safeguarding of certain "protected health information" (as defined therein) received or created
by the business associate (a `BA Agreement'); and
WHEREAS, PDA, in the performance of its services in connection with the Health Plan,
may be deemed a "business associate" within the meaning of the Privacy Rule; and
WHEREAS, the Parties desire to enter into an agreement intended to satisfy the BA
Agreement requirement and related requirements under the Part D Program (as defined in the Service
Agreement) as and to the extent such requirement may be applicable.
NOW, THEREFORE, in consideration of the premises and the respective covenants and
agreements herein contained, the Parties agree as follows:
AGREEMENT
1. Definitions
Capitalized terms not expressly defined in this Agreement shall have the meanings
as defined in the Privacy Rule. For purposes of this Agreement:
(a) "Designated Record Set" shall have the same meaning as the term "designated record
set" in 45 CFR 164.501 in respect of the Health Plan.
(b) "Effective Date" shall have the meaning as set forth in Section 7(a) of this Agreement.
(c) "ERISA" shall mean Employee Retirement Income Security Act of 1974, as amended,
and the regulations hereunder.
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(d) "Individual" shall have the same meaning as the term "individual" in 45 CFR 164.501
and shall include a person who qualifies as a personal representative in accordance with 45 CFR
164.502(g).
(e) "Health Plan Administrator" or "Plan Administrator" shall have the same meaning as
set forth in the Health Plan's Plan Document.
(f) "Privacy Rule" shall have the meaning as set forth in the RECITALS portion of this
Agreement.
(g) "Protected Health Information" shall have the same meaning as the term "protected
health information" in 45 CFR 164.501, but limited to the information created or received by PDA from
or on behalf of the Health Plan.
(h) "Required by Law" shall have the same meaning as the term "required by law" in 45
CFR 164.501 (and as further described in 70 Federal Register 4405 with regard to compliance with the
Center for Medicare and Medicaid Services' requirement of disclosure of Protected Health Information
pursuant to 42 CFR 423.884(b)).
(i) "Secretary" shall mean the Secretary of the Department of Health and Human Services
or his designee.
0) "Service Agreement" shall have the meaning as set forth in the RECITALS portion of
this Agreement.
z Obligations of PDA
PDA agrees to:
(a) Not use or disclose Protected Health Information other than as permitted or required by
this Agreement or as Required By Law;
(b) Use appropriate safeguards to prevent use or disclosure of the Protected Health
Information other than as provided for by this Agreement;
(c) Report to the Health Plan Administrator any use or disclosure of the Protected Health
Information not provided for by this Agreement of which it becomes aware;
(d) Ensure that any agent, including a subcontractor, to whom it provides Protected Health
Information received from the Health Plan, or created or received by PDA on behalf of the Health Plan
agrees to the same restrictions and conditions that apply through this Agreement to PDA with respect to
such information; provided that the Health Plan shall not have any right to disapprove any subcontractors
of PDA or to review any agreements with such subcontractors, except to the extent specifically provided
herein;
(e) Provide, in a commercially reasonable time and manner, access to Protected Health
Information to the Health Plan Administrator to the extent necessary to meet the requirements under 45
CFR 164.524, provided that such access shall be provided only to the extent such Protected Health
Information is in the possession of PDA and is a part of the Designated Record Set.
(f) Make, in a commercially reasonable time and manner, any amendment(s) to Protected
Health Information that the Health Plan Administrator directs or agrees to pursuant to 45 CFR 164.526,
BA K v3 2 7/29105
provided that such amendment(s) shall be made only to the extent such Protected Health Information is in
the possession of PDA and is a part of the Designated Record Set;
(g) Make available to the Health Plan, in a commercially reasonable time and manner,
information in the possession of PDA as and to the extent required for the Health Plan to respond to a
request by an Individual for an accounting of disclosures of Protected Health Information in accordance
with 45 CFR 164.528;
(h) Make internal practices, books, and records relating to the use and disclosure of Protected
Health Information received from the Health Plan, or created or received by PDA on behalf of the Health
Plan, available to the Secretary for purposes of the Secretary determining the Health Plan's compliance
with the Privacy Rule.
3. Permitted Uses and Disclosures by PDA
(a) General Use and Disclosure Provisions. Except as otherwise limited in this Agreement,
PDA may use or disclose Protected Health Information to perform its duties, functions, activities, or
services for, or on behalf of, the Health Plan or its Plan Sponsor, provided that such use or disclosure
would not violate (i) the Privacy Rule if done by the Health Plan or (ii) the minimum necessary policies
and procedures of the Health Plan as communicated by the Health Plan Administrator to PDA.
(b) Specific Use and Disclosure Provisions.
(i) PDA, may use Protected Health Information for the proper
management and administration of PDA or to carry .out the legal responsibilities
of PDA.
(ii) Except as otherwise limited in this Agreement, PDA may disclose Protected
Health Information for the proper management and administration of PDA or to
carry out the legal responsibilities of PDA, provided that:
(A) Disclosures are Required By Law, or
(B) PDA obtains reasonable assurances from the person to whom the
information is disclosed that it will be held confidentially and used or
further disclosed only as Required By Law or for the purpose for which
it was disclosed to the person, and the person notifies PDA of any
instances of which it is aware in which the confidentiality of the
information has been breached.
(iii) Except as otherwise limited in this Agreement, PDA may use Protected Health
Information to provide Data Aggregation services as permitted by 45 CFR
164.504(ex2)(i)(B).
(iv) PDA may use or disclose Protected Health information to report violations of law
to appropriate Federal and/or State authorities to the extent consistent with 45
CFR 164.5020).
(v) Except as otherwise limited in this Agreement, PDA may disclose Protected
Health Information to other "business associates" (within the meaning of the
Privacy Rule) of the Health Plan to perform its duties under the Service
Agreement. Notwithstanding any provision hereof or any other prior agreement
by the Parties, it shall be the Health Plan's sole responsibility (and not PDA's
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responsibility) to ensure that the Health Plan has entered into appropriate
business associate agreements with its business associates.
(vi) Except as otherwise limited in this Agreement, PDA may disclose Protected
Health information to the persons to whom the Health Plan Administrator directs
PDA to provide Protected Health Information. Notwithstanding any provision
hereof or any other prior agreement by the Parties, it shall be the Health Plan's
sole responsibility (and not PDA's responsibility) to ensure that the Health Plan
has, in its official plan document, appropriate provisions regarding disclosures of
Protected Health Information.
4. Obligations of the Health Plan and Health Plan Administrator
(a) General. Except as otherwise specifically provided under this Agreement, the Health Plan
shall not request or permit PDA to (and shall not cause the Health Plan Administrator to request or permit
PDA to) use or disclose Protected Health Information in any manner that may not be permissible under
the Privacy Rule if done by the Health Plan.
(b) Notification of Privacy Practices and Restrictions. The Health Plan shall cause the Health
Plan Administrator to promptly notify PDA of:
(i) Any limitation(s) in the Health Plan's notice of privacy practices in accordance
with 45 CFR 164.520, to the extent that such limitation may affect PDA's use or
disclosure of Protected Health Information;
(ii) Any changes in, or revocation of, permission by Individual to use or disclosure of
Protected Health Information, to the extent that such changes may affect PDA's
use or disclosure of Protected Health Information; and
(iii) Any restriction to the use or disclosure of Protected Health Information that the
Health Plan has agreed to in accordance with 45 CFR 164.522, to the extent that
such restriction may affect PDA's use or disclosure of Protected Health
Information.
S. Disclosure to CMS for Part D Program
Pursuant to 42 CFR 423.884(b) and notwithstanding any provision herein to the contrary, the
Health Plan agrees that the Health Plan, the Health Plan Administrator or PDA (on behalf of the Health
Plan) may disclose Protected Health Information to the Center for Medicare and Medicaid Services
(CMS) to the extent necessary to comply with Subpart R of 42 CFR Part 423 (relating to Notices of
Creditable and Non -Creditable Coverage and applications for drug subsidy payment to the Plan Sponsor
in connection with the prescription drug benefit under the Health Plan).
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6. Security of Electronic Protected Health Information
(a) PDA has implemented administrative, physical, and technical safeguards that
reasonably and appropriately protect the confidentiality, integrity and availability of the
electronic protected health information that it creates, receives or transmits on behalf of the
Health Plan ("ePHI") as required under the Security Standards 45 C.F.R. Part 160 and 164
subpart C.
(b) PDA agrees that it will ensure that agents or subcontractors to whom it provides
ePHI agree to implement the reasonable and appropriate safeguards to protect its confidentiality,
integrity and availability.
(c) PDA agrees to report to the Health Plan any Security Incident (as defined in 45
C.F.R. Part 164.304) within one business day after it becomes aware of any such Security
Incident.
(d) The Health Plan agrees and understands that the Health Plan is independently responsible
for the security of ePHI in its possession, whether it was created by the Health Plan or received from
outside sources (including PDA).
7. Term and Termination
(a) Term. The term of this Agreement shall be for a period commencing as of the effective
date of the Service Agreement and ending when all of the Protected Health Information provided by the
Health Plan to PDA, or created or received by PDA on behalf of the Health Plan, is destroyed, returned to
the Health Plan or further protected in accordance with the termination provisions in this Section 7.
(b) Termination for Cause. Upon the Health Plan Administrator's knowledge of a Significant
Breach of PDA's obligation under this Agreement and subject to Section 7(c) hereof, the Health Plan
Administrator may commence termination of this Agreement by providing a notice of termination to
PDA. Notwithstanding the foregoing, this Agreement shall be considered to have been terminated
pursuant to this Section 7(b) only if, prior to such notice of termination:
(i) The Health Plan Administrator shall have given to PDA written notice
describing with specificity the Significant Breach;
(ii) A period of 60 days from and after the giving of such notice shall have
elapsed without PDA's having cured or remedied such reason for termination during such
60-day period; and
(iii) A final determination shall have been made by the Health Plan
Administrator that Significant Breach persists, following a meeting at which PDA shall
be entitled to appear and contest the determination.
(c) Condition Precedent. Upon receipt of a notice of termination pursuant to Section 7(b)
hereof, or for termination of this Agreement for any other reason, PDA shall return all Protected Health
Information received from the Health Plan, or created or received by PDA on behalf of the Health Plan,
that PDA still maintains in any form, and shall retain no copies of such information. If PDA determines
that such return is not feasible, PDA shall extend the protections of this Agreement to such Protected
Health Information and limit further uses and disclosures of such Protected Health Information to those
purposes that make the return or destruction infeasible.
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(d) Report to Secretary of HHS. If, in the reasonable determination of the Health Plan
Administrator, termination of the Agreement pursuant to Section 7(b) hereof is not feasible, the Health
Plan Administrator shall report the Significant Breach to the Secretary.
8. Other Provisions
(a) Separate from Service Agreement. Except to the extent specifically provided herein, this
Agreement shall not be construed, and is not intended, to be a part of the Service Agreement or to
otherwise impose on PDA any duties, responsibilities, obligation whatsoever in respect of the
administration of the Health Plan, including any duties, responsibilities or obligation of the Health Plan
pursuant to the Privacy Rule.
(b) No Liability. To the fullest extent permitted by law, PDA shall be under no liability for
any use or disclosure made in accordance with the directions of the Health Plan.
(c) No Duty to Question. Notwithstanding anything herein to the contrary, PDA shall not be
under any duty to question any directions received from the Health Plan Administrator, nor to review in
any respect the manner in which any fiduciary of the Health Plan exercises its authority and discharges its
duties with respect to the Health Plan.
(d) Amendment. The Parries agree to take such action to amend this Agreement from time to
time as is necessary for the Health Plan to comply with the requirements of the Privacy Rule.
(e) Ambi ities. Any ambiguity in this Agreement shall be resolved in a manner that is
consistent with the applicable requirements under the Privacy Rule.
(f) Notice. Any notice required to be given hereunder shall be in writing and delivered by
hand or sent by facsimile, registered or certified mail, return receipt requested, or by air courier, to the
address (or fax number) cited in the signature block of this Agreement or to such other address (or fax
number) as shall be specified by like to notice by either Party, and shall be deemed given only when
received.
(g) Headings. The title, headings, and subheadings of this Agreement are solely for the
convenience of the Parties and do not effect the meaning or interpretation of any provision of this
Agreement.
(h) Governing W. Except to the extent preempted by ERISA, this Agreement shall be
governed by and enforceable in accordance with the laws of the State of California without giving effect
to the principles of conflict of laws thereof.
(i) Arbitration. The parties agree that any and all disputes arising out of or in relation
to this Agreement, including without limitation any action in tort, shall be resolved exclusively,
finally and conclusively by arbitration in Los Angeles County, California under the auspices of
and pursuant to the rules of the Judicial Arbitration & Mediation Services Inc. (JAMS). Each
party will select an arbitrator. Those two arbitrators will then select a third. The three member
panel will make the final decision. All decisions of the arbitrators shall be in writing, and the
arbitrators shall provide written reasons for their decision. The arbitration decision shall be final
and binding on the parties. Notwithstanding the foregoing, the parties shall be permitted to
access the court system to enforce any arbitration award or to obtain injunctive relief. The
exclusive jurisdiction and venue for any such action shall be the Superior Court of California,
BA K O 6 7/29/05
Los Angeles County. Any and all contracts between PDA and any subcontractor shall include
the same arbitration clause.
0) Entire Agreement. This Agreement and the Service Agreement contain the entire
understanding between the Health Plan and PDA with respect to the subject matter hereof and, except as
specifically provided herein, cancels and supersedes any and all other agreements between the Health
Plan and PDA with respect to the subject matter hereof. Any amendment or modification of this
Agreement shall not be binding unless in writing and signed by both the Health Plan and PDA.
(k) Severability. In the event that any provision of this Agreement is determined to be invalid
or unenforceable, the remaining terms and conditions of this Agreement shall be unaffected and shall
remain in full force and effect, and any such determination of invalidity or unenforceability shall not
affect the validity or enforceability of any other provision of this Agreement.
(1) No Benefit to Others. The representations, covenants and agreements contained in this
Agreement are for the sole benefit of the Parties, and they shall not be construed as conferring, and are
not intended to confer, any rights on any other peisons.
(m) Counterparts. This Agreement may be signed in counterparts, each of which shall be an
original, with the same effect as if the signatures thereto and hereto were upon the same instrument.
IN WTI'NESS WHEREOF, the Parties have entered into this Business Associate Agreement,
effective as of the Effective Date.
HEALTH PLAN
Date: By;
/XA
Name: Willard G. ag
Title: Chief Deput ity Attorney Acting Risk Manager
Address: 4305 Santa Fe venue
Vernon, CA 90058
Fax Number: 3) 826-1439
PART.D ADVISORS, INC.
v2-i.3-�� �' Date: By;
Name: D N
Title:
Address:
Fax Number:
BA K v3 7 7/29/05
Acknow edgement by Plan Sponsor CITY OF VERNON
By: •
Name: Willard G Y agu
Title: City Attorne /Acting Risk Manager
Date: — — I
BA K v3 8 7/29/05