Res 103-2010 9/21/2010 RESOLUTION NO. 103-2010
Resolution Approving An Agreement With The Health And Human
Service Commission (HHSC) And The Health District To Perform
Medicaid Administration Activities
WHEREAS, the Wichita Falls — Wichita County Public Health District and the
Health and Human Services Commission desire to enter into an agreement to provide
Medicaid administrative services; and,
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY
OF WICHITA FALLS, TEXAS, THAT:
The attached Interagency Cooperation Contract with the Health and Human
Services Commission to allow the Health District to perform Medicaid administrative
activities and receive reimbursement for those activities is approved, and the City
Manager is authorized to execute the Interagency Cooperation Contract on behalf of
the City of Wichita Falls with such changes as are approved by the City Attorney.
PASSED AND APPROVED this the 21 day of September, 2010.
MAYOR
ATTEST:
'ty Clerk
Interagency Cooperation
Contract
STATE OF TE�A.S §
COU'NTY OF TRAVIS � INTERAGENCY' COOPERATTON CO:VTRACT
THTS AGTtEEMEtiT is entered into by and between the state agencizs shown below, pwsuant to the
authority graxited and in compliance with the pxovisions of the Interageney Cooperation Act, Chapters 771
and 791, Texas Governtnent Code.
I. MEDICAID ADMINISTRATION
Local liealth bepa�vneut l�ereafter referenced as "LFID"
agrees to perform Medicaid Administrati��e acuvities on behalf of the Health and TTuman Services
Commission (HHSC) to improve the availability, ac:cessibility, coordination and appropriate utilization of
preventive and remedial health care resources to Medicaid eligible clients azid cheir families. These
at;tivities �vill be in accordance �vith the policies aud procedures set forth iu Ute Medicaid AcLuuustrative
Claiming Guide hereafter referenced as "the Guide" and its appendices as issued by HHSC. Allowabie
activities undar Medicaid a�nini+tration are described in detail in the guide. Attachment A- Bwiness
Associafe Agreement is aitached hereto and incorporated herein for all purposes.
The LHD agraes to accouut far the acti��ities of staff providing Mcxiicaid administration u� accordance with
the provisions of Oi�1B Circular A-R7 and 45 CFR Part 74 and 95, and with the written guidelines issued by
HHSC.
The LHb agrees to perform or coordinate its subcontractors' performance of Medii;aid administrative
activities on behalf of T-II-ISC to unprove the a��ailability, accessibility, coordination and appropriate
utilization of prevenuve and remedial health caze resources to Medicaid eligible clients and their families.
These activities will be in accordance with the policies and proceduras set forth in the Medicaid
Administraiive Claiming Guide.
The LHD a�rees to submit its quarterly time study calculations for claiming purposes. All claims shall be
submitted using the HHSC standardi�ed invoice included in Attachmznt B. All claims shall be submitted
on the last day of the sixth month following the end uf lhe quarterly claim period, unless the last day of the
61h monfh falls on a weekaud. Tn such uvstance, the clain� will be due the next business day.
The LHD agrees to provide support for any expenditures information included in the quarterly claims data
it submits to HHSC, or its designee, in tl�e manner and timeframes describexl in the HHSC Medicaid
Administrafive Claiming Guide.
The LHD agrees to spend the State General Revenue, in an amount equal to the fecieral match received, for
health-related services for clients.
The C.HD agrees to spend ihe £ederal match dollars generated from Medicaid administrative activities for
health-related services for clients.
The LHD agrees to designate an employee to act as a liaison wilh HIISC for issues concerning �lus
Agreement.
Any audit exception, deferral or denial taken against this agreement will be the responsibiliry of The LHD.
LL(UENERAL RESPONSIBIL.[TY
HI ISC recognirss the unique relationship that The L}LD, and the a�liated entities operaiing under contracl
or memorandum of understan��ing with it, has with its Medicaid eligible clients. HHSC further recogni2es
the expertise of The LHD in identifying and assessing the health care needs of Medicaid eligible clients it
serves and in planning, coordinating, and monitoring the delivery of preventive and treatment services to
meet their needs. HHSC, in ordei to take advantage uf this expratise and relationship and to promote tl�e
proper and efficiant administration of lhe State Medicaid Plan, has entered into this agreement with the
LfID effective upon execution.
III�SC and The LHD enter info this agraement with full recognition of its relationship to any other
agreements that HHSC may have devalopad for services to Title �LX eligible clients living in Texas and
which aze cwrently included in the Title 11X Medicaid Staze Plan.
III. BASIS FOR CALCULATING REIMBURSABLE COSTS
HHSC agees to pass through to The LHD no less than ninety-five percent (45°'a) of Title XIX federal share
of actual and reasonable c;osts for Medicaid Adminis[ration provided by its staff for Medicaid
administrative activities under this agreemenL HHSC reserves the right to retain five percent of the Title
XLX federal share of actual and reasonable cosu for said n9edicaid administration for HIISC's own
administrative costs.
The rate of reimbursement for allowable administrative activities performed by personnzl otlter than Skilled
Professional Medical Persoimel (SP;vIP) shall bz 50 percent of such costs. The rate of reimbursement fur
activities qualifyiug under regulations applying to SPMP and their direct supporting clerical staff shall be
75 perceut of such costs fur activities identified as `.`nnhanced" ur 50 percent for activilies identified as
"non-entianced." Categories oY costs eligible for 75 percent raimbursement include the following itews
only: cornpensation and applicable fringe benefits, travel and training of SPMP and thair direct supporting
clerical staff.
HHSC agrees to reim6urse The LFID subject to the terms of the HHSC Medicaid Administrative Claiming
Guide. The rate of reimbursement for allowable. administrative activities performed by personnel other
than Skilled Professional Medical Personnel (SP.'�1P) personnel shall be fifty percent (50°•o j of such costs.
When maaie awaze of changes in fedexal regulatious affecting the matching percenlage, or costs eligible Yor
enhanced or administrative tuatch, which bewme effective subsequent to the execution of the Agreement,
HHSC wil] apply such changes to comply with federal regulations. As HHSC becomes aware of changes
in applicable regul:Uions, it will provide such information to The I.HD and this Agreement will be amended
to reflect the applicable changes in federal rngulafions.
I{HSC agrees to include The Prograzn's expenditures for Medicaid administration in the claim it submits to
CMS for TiAe XLX federal participation, if said claim is suUmitted in accordance with u�itten time&ames
as laid out in this agreement and the cunent Texas Department of Health Medicaid Adminutrative
Claiming Guide.
HHSC agrees tu reimburse claims for Me.iicaid administration from The LHD only if The LHD cettiCies
that sufficient funds are available to suppoit the non-federal shaze of the cust of the clauv (or "matcN').
Agreement is also subject to any additional restrictious, limitatiot�s or conditions required by federal or
state laws, rules oc cegulatious.
}[HSC agrees to designate staff to act as liaison with The LHD for issues concernin� this agreement.
IV. TF.RM OF AGREEMENT
This ag,.reement is lo begin upon executiou and shall continue until tenninaYed by either FC}CSC or the LHD.
This agreement may be tenuinated by consent of either HHSC or T1ie LT-rD upon Uiirt,y (30) days notice in
wnting delivered in person or by certified mail.
V. CERTIEICATIOrS
The undersigned contracting pafties certify that:
• the services specified above are necessary and essential for activitias that are properly within the
statutory funetions and programs of the affected agencies of state govemment;
• the proposed arrangements serve the interest o£ efficient and economical administratiou of state
govenuneut; and
• the services contracted for aze not required by Section 21, azticle YVT of ihe Te�s Constituiion lo
be supplied under a contract awarded to die ]owest responsible bidder.
The LHD futther certifies that it has sufficient statutory authoriry, W contract for the services described in
this contract under Chapter 12, Tesas Health and Safety Code.
HHSC further certifies that it has sufficient statutory authority to contract for the sen�ices described in this
contract iuider Chapter 531, Tea:as Govemment Code.
T'his agreemeut is executed by the parties in their capacities as statad below.
RECEIVING AGENCY PERFORMING AGENCY
HEALTH & HUMAN SERVICES COMMISSION LOCAL HEALTH DEPARTMENT
B y —..-- �Y --
Billy Millwee
Acting 9ssociate Commissioner for :�ledicaid & E�:ecutive Director/CEO
CTTCP
Date: Date:
HHSC
STATE OF TE�AS
Cocnvr� ox Txnv[s
AGREEMEl\T
BETWEEN THE
TEXAS AEAI,TH .#ND HLTM.AN SERV[CES COMMISSION
AND
(INSERT CONTRACTOR NAb1E)
SUSINESS ASSOCIA'TE AGREEMENT
Compliance with Healtl� Insurance Portability and Accouutability Act of 1996
("HIPAA"} (42 U.S.C. �§1320d-1320d-8)
This Business Associate Agreement relates to tl�e Agreement between the Health and
Human Services Commission ("HHSC") and CONTRACTOR NAME
{"CONTRACTOR"). It is incorporated by reference into the lntergovernmental
Agreement.
(a) Background.
(1) All terms used in this Busiuess Associate Agreemeot that are not othenvise defined in
this Agreement have the same meaning as those terms in the Privax;y Rule, 45 C.F.R. parts 160
and 164;
(2) Uuder the terms of this A��eement, HHSC may provide m• make available to
CONTRACTOR, or CON"TRACTOR may create or receive on behalf of HHSC, certain
Coufidential Informaxion that is and must be afforded special treatment and protection under Uie
Health Insurance Portability and Accountability Act of 1996 ("HIPAA") (42 U.S.C. §§1320d-
1�20d-8) in coqjunction with goods or services that are being provided to HHSC by
CONTRACTOR;
(3) CONTRACTOR will have access to or receive from HHSC or create receive on behalf of
HHSC certain electronic protected health information that must be safeguarded in a�;cordance
with this Ageement and the security rules adopted Uy the U.S. Deparhnent of Health and Human
Services (HHS) under HIPAA, 45 C.F.R. §$ 164.302-.318. CONTRACTOR is a Business
Associate as �hat term is defined in the HIPAA sewrity rules, 4� C.F.R. § 160.103.
(4) CONTRACTOR is a Business Associate of HHSC.
(51 The obligations of CONTEtACTOR under this section aze in addition to the duties of
CONTRACTOR with respe�;t to Conlidential Infonnation described elsewhere in diis Agreement.
(b) LTses arrd Disclosures.
Except as odierw�ise limited by this A��eement, CONTRAC'I'OR may:
(1) Use or disclose Protected Healch luformation to perform the 5ervices and a4;complish the
purposes of this Agreement, provided that:
(A) Such use or disclosure would not yiolate the Privacy Rule if the disclostue were
made Uy HHSC; arid
(B) 5uch use or disclosure is limited to the minimum uecessary to accomplish the
purposes of the use or disclosure;
(2} Use Protected Health Inforn�aiion for the proper management and administration
of CONTRACTOR or to carry out CONTRACTOR's legal responsibilities;
(3} Disclose Protected Health Information for the proper management and
administration of GONTRACTOR or to carry ouf CONTRACTOR's legal
responsibilities if:
(A) Dixlosure is required hy law; or
(B} CONTRACTOR obtains assurances from the person to whom the information is
disclosed that the person wi11:
(i) MainYain the confidentiality of the Protected Health Informatiov;
(ii) Us2 or Iurther disclose the information only as required by law or i'or the purpose
fm• which it was disclosed to the person; and
(iii} Notify CONTRACTOR of' any brt;aches of contidentialiry of which the person is
awaze; and
(4} Use Protected Health Information to provide data aggregatiou services to HHSC,
as that tenn is defined at 45 C.F.R. § 164.501 and pennitted by 45 C.F.R.
� 164.504('e}(2)(i)(B).
(c) CONTR,1 CTOR's commitment and obligations.
CONTRACTOR agrees that it will:
(1) Not use or disclose Proteti;ted Healdi luformation provided by, made available by, or
created or received on behalf of HHSC other than as permitted or required by this Agreement or
aa required by law;
{?} Establish and maintain appropriate safeguazds to prevent any use or disclosive oY
Protected Health Info�matiou other than as psovided far by diis Agreement;
(3) Have pro�;edw•es in place for mitigatin„ to the maximum extent practicable, a�y hannful
effect of a use or disclosure of Protected Health Information that is contrary to this A�eement or
the Pri��acy Rule;
(4) Urnnediately repmt to HHSC any use or disclosure o'f Protected Health ]n'formation not
provided for or allowed by this Agreemeut of which CONTRACTOR Uecomes awaz�e;
(51 Enter into a subcontract anytime GONTRACTOR proposes to provide or make available
Protected Health Information to any subcontractor or agent. Such subcontract or agreement must:
(A) Contain die sa�ne tenns, conditio��s, a�id restrictious on the use and disclosure of
Protected Health Information and restrictions on the security of information as contained in
this Agreement; and
(B) Be approved as to the foiYn of the terms, conditions, and restrictions by HHSC prior
to entering ioto �ry suc2� agreernent;
(6) Make Protected Health lnformation in a designated records set available to HHSC or, as
directed by HHSC, to the subject of the Protected Health Information, in compliance with the
requiremenCs of45 C.F.R. §164.524.
(7) Make Protected Health Infom�auon in a designated records set available for amendment
atid will nicorporate aziy amendineuts to this inforniation that HHSC directs or a�•ees to pursuant
to 45 C.F.R.§164.526.
(81 Document and make available to HHSC the Prote.:ted Health ]nformatioo required to
provide an accounting of disclosures,in accordance with 45 C.F.R.§164.�28.
(9) Make internal prati;tices, books, and records relating to the use or disclosure of Protected
Health Informauon received from, or created or received by CONTRACTOR on behalf of HHSC.
available to the Secretary of Health and Hiunan Services or the Secretary's designee for purposes
of detenniniug compliance with the privacy regulations.
(10) Retum, destroy, or continue to maintain approp�iate safeguards for all 1'rotected Health
Information received from HHSC or created or received on behalf of HHSC once
CONTRACTOR finishes providing goods or services under tliis Agreement:
(A) If CONTRACTOR destroys the inf'ormation, it must certify to HHSC that the
information has been desuoyed;
(Bl CONTRACTOR may not elect to destroy infonnation that must be retained under
f'ederal or state law; and
(C) CC)NfRACTOR must maiotain a}�propriate safeguards for tl�e inforniation as long as
CONTRACTOR has such Protec[ed Healdi InYormation;
(11) Develop and implement a system of sanctions for any employee, subcontractor, or agent
who violates this Agreement or Yhe Privacy Rule.
(12) Implement administrative, plrysical, and tecbnical safeguards that reasonably and
appropriately protect the confidentiality, integrity, and availability of the electronic
protected healfh infomiation that it creates, rec;eives, maintains, or transmits on behalf of
HHSC as required by 45 C.F.R. §§ 164. �02-.318.
(13) Immediately report to HHSC �ny security incident ofwhich it becvmes aware.
(14} Make internal practices, Uooks, and records relating to the securiry of information
received from or created or received by CON'I'RACTOR on behalf of HHSC available to the
Secretary of Health and Human Servic�.s ar the Secretary's designee for pw of determinuig
compliance with the securiry rules.
(15) Develop and implement a system of sanctions for any employee, subcontractor
or agent who violates this agreement ar the security rules.
(d) Ownership of'Protected Health !nf'ormaiwn.
(1} The Protected Health Inforn�ation shall be and remain the property of HHSC.
(2) CONTRACTOR agrees it acquires no title or rights to the information, including any de-
identified information, as a result of this Agreement.
{e) Injunclive relief,• survivul o/'lerms.
(1) Notwithstanding any rigl�ts or remedies provided for in [he contact, HHSC retains all
rights to seek injunctive relief to prevent or stop tl�e unau[horized use or disclosure of Protected
Health Inii�imation or � violation of the security rules by CON'I'RACTOR or any agent,
subcontractor, or third party that received information from CONTRACTOR.
{2) The duties and obligations imposed on CONTRACTOR under this sec,tion of this
Agreement will sLUVive the expiration of the Ageeinent uutil all Protected Health Infoimation
provided by HHSC to CONTRACTOR, or created or received by CONTRACTOR on behalf of
HHSC, is destroyed or retmned to HHSC.
(� Defstitions.
(l) For purpose;s of this Busmess Associate Agreement a"Business Associate" has the
meaning given the term under 4� C.F.R. § 160.103.
(2) For purposes of this Bu�iness Associate Agreement, "Protected Health Inforn�arion" has
the meaning giveu the term in 45 C.F.R. § 164.501, lunitec� to the information created or received
by CONTRACTOR from or on behalf of FIHSC.
(� Generul Terms
(lj Faccept as otheitivise speeiiied in tl�e contraet, if any legal actian or other proeeeciing is
brought for the enforcement of the contract, or because of an alleged dispute, breach, default,
misrepresentation, or injunctive action, iu connection with any of the provisions of the contract,
each party will bear their own legal expenses and all other costs incurred in that action or
proceeding.
(2} The eontract consists of this document and the base contract and constitutes the
entire agreemznt between the parties. There are no understandings or agreemen[s relating
to this agraement or the base contract that ara not fully expressed in the contracf aud no
change, waiver, or discharge of obligations arising under the contract wiil be valid unless
in writing anc� executed by the party against whom such change, waiver, or discharge is
sought to be enforced.
(3} Any violation by COl\"TRACTOR of a material term of this agreement will be
considered a breach of contract if COIVTRACTOR lmew of the violation and failed to
immediately take reasonable steps to cure it.
(4} HHSC has a right to immediately temunate this agreement and the base contract
and seek relief in a court of competent jurisdiction in Travis County, Texas, if HHSC
deternunes that CONTRACT'OR has violated a material term of this agreement.
SIGNED this day of , 2010.
{INSERT CONTRACTOR �AME�
By:
Printed Name and Title