HomeMy WebLinkAboutCAG2003-0526 - Other - NorthStar Administrators - Business Associate Addendum to Administrative Service Contract for Erisa Groups - 04/14/2003 BUSINESS ASSOCIATE ADDENDUM TO
ADMINISTRATIVE SERVICE CONTRACT
FOR ERISA GROUPS
An Administrative Service Contract(the "Agreement") was entered into by and between
NorthStar Administrators (the"Claims Administrator") and City of Kent(the "Plan Sponsor")
on January 1, 2003. This Business Associate Addendum(the "Addendum") shall be entered into
by and between the Claims Administrator, the Plan Sponsor and the Group Health Plan(the
"GHP") (as defined below) effective on April 14, 2003 (the"Effective Date"), and shall be
incorporated into and be made a part of the Agreement.
Recitals.
1. In 1996, Congress enacted the Health Insurance Portability and Accountability Act
("HIPAA"),which required, among other things, the promulgation of privacy rules
governing the use and disclosure of protected health information.
2. In pertinent part, the HIPAA privacy rules, codified at 45 C.F.R. Parts 160 and 164,
subparts A and E, and as amended(the "Privacy Rule") require that covered entities,
including the GHP,maintain business associate agreements with third parties that provide
certain services for and on behalf of the GHP, including the Claims Administrator, and
outline specific contractual requirements to be incorporated into the business associate
agreements.
3. In addition to being the business associate of the GHP, the Claims Administrator is a
member of a holding system of health plans that includes covered entities, as defined in
the Privacy Rule, and as such has policies, procedures and practices in place,which are
applied consistently to each member of the holding system, in order to ensure compliance
with the Privacy Rule.
4. Because the Claims Administrator is regulated under other state and federal privacy laws,
it has adopted the term"protected personal information' or"PPI" (as defined below) and
will apply the obligations contained in this Addendum to that information.
5. Thus, the Plan Sponsor, the GHP and the Claims Administrator mutually agree to amend
the Agreement to incorporate the terms of this Addendum to comply with the Privacy
Rule.
NOW, THEREFORE, in consideration of these premises and the mutual promises and
agreements hereinafter set forth,the Plan Sponsor,the GHP and the Claims Administrator
hereby agree as follows:
1. Definitions. The following definitions shall apply in interpreting this Agreement. Terms
used, but not otherwise defined shall have the same meaning as those terms in the Privacy
Rule (as defined below):
1.1 Group Health Plan or GHP. The GHP shall be defined consistent with 45 CFR
164.103, and as amended.
1.2 Individual. "Individual'shall mean the person who is the subject of the PPI or
their personal representative (as defined in §164.502(g) of the Privacy Rule).
1.3 Protected Personal Information or PPI. "PPI" shall mean any and all information
created or received by the Claims Administrator,that identifies or can readily be
associated with the identity of an Individual, whether oral or recorded in any form
or medium, that directly related to: (1)the past, present or future physical, mental
or behavioral health or condition of an Individual; (2) the past, present or future
payment for the provision of health care to an Individual; (3) the provision of
health care to an Individual; and (4)the past, present or future finances of an
Individual, including,without limitation, an Individual's name, address,telephone
number, Social Security Number, subscriber number or wage information.
1.4 Secretary. "Secretary" shall mean the Secretary of the Department of Health and
Human Services or his designee.
2. GHP. The Claims Administrator, Plan Sponsor and GHP all agree to add the GHP as a
party to the Agreement and acknowledge that the GHP's obligations under the
Agreement are contained completely in this Addendum.
3. Safeeuard of PPI. The Claims Administrator will maintain reasonable and appropriate
administrative, technical and physical safeguards, as required by applicable laws to
protect against reasonably anticipated threats or hazards to, and to ensure,the security
and integrity of PPI,to protect against reasonably anticipated unauthorized use or
disclosure of PPI and to reasonably safeguard PPI from an safe uar intentional or unintentional
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use or disclosure in violation of the Addendum.
4. Permitted Uses and Disclosures of PPI by the Claims Administrator.
4.1 Functions and Activities on the GHP's Behalf. The Claims Administrator shall be
permitted to use and disclose PPI for(a)the management, operation and
administration of the GHP and (b) as otherwise necessary to provide the services
set forth in the Agreement, including,but not limited to activities related to
Payment and Health Care Operations as defined in §164.501 of the Privacy Rule.
4.2 Disclosures to the Plan Sponsor, the GHP or other Business Associates of the
GHP. Except as otherwise permitted by this Addendum or another written
directive from GHP, the Claims Administrator, will not disclose PPI to the Plan
Sponsor,the GHP or to another business associate of the GHP. The Claims
Administrator, may disclose PPI only to those individuals employed by the GHP,
Plan Sponsor or other business associates of the GHP, including, without
limitation, the GHP's broker, identified in Exhibit G-1, which is attached hereto
and incorporated herein. The GHP must promptly notify the Claims
Administrator of any changes to Exhibit G-1.
4.3 Functions and Activities on the Claims Administrator's Behalf. The Claims
Administrator shall be permitted to use PPI as necessary for the Claims
Administrator's management and administration or to carry out its legal
responsibilities as permitted or required by law. The Claims Administrator shall
also be permitted to disclose PPI to its business associates, subcontractors or other
third parties as necessary for proper management and administration of the
Claims Administrator, or to carry out the Claims Administrator's legal
responsibilities (a) if the disclosure is required by law or (b) if before the
disclosure is made, the Claims Administrator, obtains a contract from the entity to
which the disclosure is to be made containing reasonable assurances that the
entity will also comply with the Privacy Rule's business associate requirements.
5. Minimum Necessary. The GHP and the Plan Sponsor will make reasonable efforts to
request from the Claims Administrator only the minimum amount of PPI necessary for its
needed purpose. In addition,the GHP and the Plan Sponsor will make reasonable efforts
to only disclose to the Claims Administrator the minimum amount of PPI necessary for
the Claims Administrator to perform the services identified in the Agreement and other
functions and activities referenced in Section 3 of this Addendum. Finally, the Claims
Administrator will make reasonable efforts to use, disclose, or request only the minimum
amount of PPI necessary from any third party to perform the services identified in the
Agreement and other functions and activities referenced in Section 3 of this Addendum.
6. Other Privacy Obligations of the Claims Administrator. The Claims Administrator
shall:
6.1 Not use or further disclose PPI other than as permitted or required by the
Agreement, the Addendum or law;
6.2 Report to GHP any actual use or disclosure of PPI concerning GHP's Participants,
Dependents and Beneficiaries not permitted or required by the Agreement, the
Addendum or law of which it becomes aware;
6.3 Ensure that any agents, including a subcontractor,to whom it provides PPI
received from, or created or received by the business associate on behalf of,the
GHP agree to the same restrictions and conditions as outlined in the Privacy Rule
that apply to a business associate with respect to such information;
6.4 Make available PPI as required by §164.524;
6.5 Make available PPI for amendment and incorporate any amendments to PPI as
required by §164.526;
6.6 Make available the information required to provide an accounting of disclosures
as required by §164.528;
6.7 Make its internal practices, books, and records relating to the use and disclosure
of PPI received from, or created or received by the Claims Administrator on
behalf of, the GHP available to the Secretary for purposes of determining the
GHP's compliance with the Privacy Rule; and
6.8 Restrict the use and disclosure of PPI in accordance with §164.522 and consistent
with the Claims Administrator's policies, procedures and practices.
7. The Claims Administrator's Privacy-Related Services Regarding Requests by
Individuals. Upon receipt, the GHP shall immediately provide notice to and forward any
and all individual requests received pursuant to §164.522, §164.524, §164.526 or
§164.528 of the Privacy Rule(collectively referred to as the "Requests") consistent with
Exhibit G-2. Upon the Claims Administrator's receipt of the Requests, either from the
GHP or directly from the Individual, the Claims Administrator shall:
7.1 Evaluate each request consistent with the Privacy Rule and the Claims
Administrator's policies, procedures and practices;
7.2 For Requests that may affect the policies,procedures or practices of the GHP,
coordinate with the GHP about evaluation of the Requests and mutually agree on
the result;
7.3 For Requests that may involve the GHP's other business associates, request
information from the business associates identified by the GHP necessary for
fulfilling the Requests;
7.4 Communicate the result of the evaluation directly to the Individual within the
legal timeframes established for each type of request; and
7.5 Notify the GHP of the outcome of each Request identified by the GHP at the time
of notice to the Claims Administrator; and
7.6 Implement each Request that is granted.
For providing such services,the GHP shall compensate the Claims Administrator
pursuant to the Fee Schedule attached as Exhibit G-3.
8. GHP's Notice of Privacy Practices.
8.1 Preparation of the GHP's Notice of Privacy Practices. Claims Administrator will
provide the GHP a copy of notice of privacy practices as it relates to the Claims
Administrator's functions and activities contained in the Agreement and this
Addendum,which the GHP shall incorporate into the GHP's Notice of Privacy
Practices(the "Privacy Notice").
8.2 Amendment of the GHP's Privacy Notice. the GHP shall be responsible for
modifying the Privacy Notice in the event that the GHP,the Plan Sponsor or the
Claims Administrator materially changes its privacy policies, procedures or
practices that affect the Privacy Notice. The party necessitating the change to the
Privacy Notice shall bear any reasonable costs associated with revising and
distributing the Privacy Notice. The GHP, the Plan Sponsor and the Claims
Administrator will not institute such material change before the effective date of
the GHP's revised Privacy Notice.
8.3 Distribution of the GHP's Privacy Notice of Privacy Practices. The GHP shall be
responsible for the distribution of its Privacy Notice, and any revisions to its
Privacy Notice within a reasonable time.
9. Term and Termination.
9.1 Term. The Term of this Addendum shall begin as of the Effective Date contained
herein and shall remain in effect for the duration of the Agreement.
9.2 Termination for Breach of Privacy Obliizations. The GHP will have the right to
terminate the Agreement if the Claims Administrator has engaged in a pattern of
activity or practice that constitutes a material breach or violation of the Claims
Administrator's obligations regarding PPI under this Addendum. The contractual
requirements for termination are outlined in the Agreement.
9.3 Effect of Termination.
a. Return or Destruction of PPI Upon Termination of Agreement. Upon
cancellation, termination, expiration or other conclusion of the
Agreement,the Claims Administrator will, if feasible, return to the GHP
or else destroy PPI, in whatever form or medium that the Claims
Administrator,created or received for or from the GHP, including all
copies of and any data or compilations derived from such PPI that allow
identification of any Individual. The Claims Administrator will complete
such return or destruction as promptly as practical, but not later than sixty
days after the effective date of the cancellation, termination, expiration or
other conclusion of the Agreement.
b. Reimbursement. The Plan Sponsor will reimburse the Claims
Administrator's reasonable costs and expenses incurred in returning or
destroying such PPI.
C. Disposition When Return or Destruction of PPI is Not Feasible. In the
event that returning or destroying the PPI is not feasible as determined by
the Claims Administrator, the Claims Administrator will limit further use
or disclosure of the PPI to those purposes that make their return to the
GHP or destruction infeasible and shall extend the privacy protections
contained herein to that PPI for as long as the Claims Administrator
retains it.
10. Order of Precedence. This Addendum shall supercede and replace any and all
provisions in the Agreement concerning confidentiality or privacy. In addition,the
notice provisions of this Addendum shall prevail over the Agreement only to the extent
that such notice is related to the obligations contained herein. Except as otherwise
provided in this section, in the event that any other terms or conditions contained in this
Addendum conflict or are inconsistent with the Agreement,the terms and conditions of
the Agreement shall prevail.
IN WITNESS WHEREOF, the parties have signed this Addendum effective as of the date
indicated above.
CLAIMS ADMINISTRATOR
pig/
Its: President
PLAN SPONSOR SIGNATURE
/Signature Printed
Its:
Dated: 4- 9 -o3
GHP
Signature Printed
Its:
Dated:
I
EXHIBIT G-1
GHP's Authorized Representatives
GHP authorizes the Claims Administrator to disclose PPI to achieve the purpose(s) as outlined
below to the following people that are (a)employed by the GHP, (b) employed by the Plan
Sponsor or (c) employed by a business associate of the GHP:
Date Entity Name Purpose for Disclosure
(mm/dd/yy) (GHP or Plan
Sponsor)
o� 3
EXHIBIT G-2
Notification Requirements
Privacy-Related Services Regarding Requests
All notices required under Section 7 this Addendum shall be given in writing, delivered by
facsimile or in person, and addressed as follows:
GHP:
(Name)
(Department)
(Telephone Number)
(Fax Number)
Claims Administrator:
NorthStar Administrators
Complaints and Appeals Department
P.O. Box 91102
Seattle, WA 98 1 1 1-9202
Telephone: 1.800.345.6784
Fax: 425.918.5592
EXHIBIT G-3
Fee Schedule for Privacy-Related Services
Administration of requests from individuals will be based on a per request basis.