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MEMORANDUM OF UNDERSTANDING Between MARICOPA COUNTY CORRECTIONAL HEALTH SERVICES AND MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT, dba MARICOPA INTEGRATED HEALTH SYSTEM This Memorandum of Understanding (“MOU”) is between Maricopa County Correctional Health Services, herein referred to as (“CHS”) and Maricopa County Special Health Care District dba Maricopa Integrated Health System, herein referred to as (“MIHS”) (collectively, the “Parties”). 1. PURPOSE: CHS and MIHS each maintain an electronic health records application system, specifically CHS’s TechCare™ system and MIHS’s EPIC system, which contain electronically stored medical information about patients, including protected health information (PHI) as defined below. The purpose of this MOU is to set forth the terms and conditions under which each party’s authorized users will be allowed to access the other party’s respective electronic health records application system in order to access patient information needed to provide and/or coordinate treatment and/or healthcare services to patients. 2. DEFINITIONS: As used throughout this MOU, the following terms shall have the meanings set forth below: A. MOU means this document and all attachments and amendments hereto. B. County means Maricopa County. C. CHS means the person, firm, individual or organization employed or contracted with Maricopa County Department of Correctional Health Services. D. Criminal Justice Information refers to any confidential information collected by criminal justice agencies on individuals consisting of identifiable descriptions and notations of arrests, detentions, indictments, information, or other formal criminal charges, and any disposition arising therefrom, as well as confidential pre-booking or booking personal identifiable information, including date of birth, social security number, age, demographic information, projected release dates and release date information as defined in 5.U.S.C. § 552 and 5 U.S.C. § 552a. E. Director means the Director of CHS. F. EPIC refers to the electronic health record software system licensed by MIHS and maintained by MIHS. G. Medical Director means the Medical Director of CHS. H. Authorized Use means the use and exchange of electronic health records in TechCare™ or EPIC, as applicable, for treatment, payment, and/or healthcare operations where permitted under federal and state law, including, but not limited to, HIPAA and 42 CFR Part 2. Circumstances for Authorized Use include the following: (i) the subject patient has signed an authorization for the release of his or her protected health information and/or protected substance abuse treatment information on a form that meets the requirements of HIPAA and/or 42 CFR Part 2, as applicable; (ii) a court order directs release of the patient’s records to CHS or MIHS, as applicable; or (iii) an exception under federal and/or state law applies, such as for the purpose of treatment as defined under HIPAA. I. Authorized Users refers to CHS and MIHS and their respective employees and contracted healthcare providers, or other specifically authorized persons identified by the parties, who are authorized to use the TechCare™ or EPIC systems to access patient electronic health records for Authorized Use. J. 42 CFR Part 2 refers to the laws governing confidentiality for people seeking treatment for substance use disorders from federally assisted programs. K. HIPAA refers collectively to the Health Insurance Portability and Accountability Act of 1996, codified at 42 U.S.C. § 1320d et seq., and the Health Information Technology for Economic and Clinical Health Act, enacted as Title XIII of the American Recovery and Reinvestment Act of 2009, codified at 42 U.S.C. § 17921 et seq., and any current and future regulations promulgated thereunder, including but not limited to 45 C.F.R. Parts 160 and 164. L. TechCare™ refers to the electronic health record software system licensed by the County and maintained by CHS. M. Protected Health Information (PHI) shall have the same meaning as defined under HIPAA and includes any information about health status, provision of health care or any individually identifiable information including Social Security Number, Age, Sex, Date of Birth, Patient Identification Number, Medical Record Documentation either paper or electronic, diagnosis, procedural information and any other information directly linked and identifiable to a specific individual under the care, safety and medical supervision of CHS. 3. SCOPE: MIHS and CHS agree to the formats and data accessibility to and from the TechCare™ and EPIC applications as follows: A. CHS shall, through normal procedures, manage TechCare™ user provisioning. MIHS shall, through normal procedures, manage EPIC user provisioning; B. CHS will extend efforts focused on application maintenance and construction associated to forms creation in regards to TechCare™. MIHS will extend efforts focused on application maintenance and construction associated to forms creation in regards to EPIC; 2 | P a g e C. Cooperative efforts with MIHS and CHS to create, establish, and define program specific forms; D. Capability to create Progress Notes and ability to attach electronic documentation amongst EPIC and TechCare™; E. Each party’s Authorized Users may access electronic health records in TechCare™ or EPIC, as applicable, when Authorized Use is permitted. Access shall be limited to “read only” files that cannot be modified or altered. Neither party warrants the electronic health records in their respective electronic health records application systems, and each acknowledges and agrees that use of the electronic health records application systems and data/electronic health records therein is at the party’s own risk; F. CHS shall supply TechCare™ application changes to MIHS as needed. MIHS shall supply EPIC application changes to CHS as needed; G. MIHS shall not be responsible to pay TechCare™ maintenance fees or modification fees. CHS shall not be responsible to pay EPIC maintenance fees or modification fees. 4. SPECIAL TERMS AND CONDITIONS: 4.1 TERM OF MOU: This MOU shall begin upon approval of the Board of Supervisors and when all signatures are affixed and fully executed by both parties. 4.2 TERMINATION: This MOU shall continue until terminated by either party with or without cause, upon thirty (30) day written notice to the other party; provided, however, that CHS may terminate this MOU, in whole or in part, immediately upon providing either written or verbal notice when CHS deems the health or welfare of a patient is endangered. Either party may terminate this agreement immediately upon providing written or verbal notice when it deems that performance would be in violation of the law or order of a court of law. 4.3 AMENDMENTS: Any changes or amendments to this MOU shall be effective only if made in writing and signed by both parties. All such changes or amendments shall be handled by formal amendment and approved by CHS authorized representative and MIHS. 4.4 RETENTION OF RECORDS: MIHS and CHS agree to maintain records and other relevant documents to this MOU for five (5) years following the termination of the MOU; provided however, if any audit questions are unresolved at the end of that five year period, all records and documents relating to such audit questions shall be maintained until those audit questions are resolved. 4.5 COMPLIANCE MONITORING: CHS and MIHS shall each monitor their own respective compliance with, and performance under, the terms and conditions of this MOU. Notwithstanding the foregoing, each party may conduct quality assurance audits from time to time to assess the proper access 3 | P a g e and utilization of their respective electronic health records application systems. 4.6 MIHS & CHS’S RESPONSIBILITY: MIHS and CHS shall cooperate hereunder in a professional manner that conforms to all local, state and federal codes, rules and within the standard of practice for the scope of each of the parties’ responsibilities. MIHS and CHS shall comply with all federal, state and local laws, ordinances, rules and regulations applicable to each party’s performance under this MOU. There are no financial responsibilities assigned by the MOU; the MOU is simply intended to allow MIHS and CHS to work together to better address the needs of the community. 4.7 NON-DISCRIMINATION: To the extent applicable, MIHS, in accordance with ARS § 41-1461, et seq., shall provide equal employment opportunities for all persons, regardless of race, color, creed, religion, sex, age, national origin, disability or political affiliation. MIHS shall comply with the Americans with Disabilities Act. 4.8 GOVERNING LAWS: This MOU shall be governed by the laws of the State of Arizona. 4.9 INDEMNIFICATION: To the fullest extent permitted by law, each party shall defend, indemnify, and hold harmless the other party, its agents, representatives, officers, directors, officials, and employees for, from and against all claims, damages, losses and expenses, including, but not limited to, attorneys’ fees, court costs, expert witness fees, and the cost of appellate proceedings, relating to, arising out of, or alleged to have resulted from the negligent acts, errors, omissions or mistakes relating to the performance of this MOU. Each party’s duty to defend, indemnify and hold harmless the other party, its agents, representatives, officers, directors, officials, and employees shall arise in connection with any claim, damage, loss or expense that is attributable to bodily injury, sickness, disease, death, or injury to, impairment, or destruction of property, including loss of use resulting therefrom, caused by any negligent acts, errors, omissions or mistakes in the party’s performance of this MOU including any person for whose acts, errors, omissions or mistakes a party may be legally liable. 4.10 CONFLICTS OF INTEREST: To the extent applicable, this MOU is subject to the provisions of A.R.S. § 38-511 relating to conflicts of interest. 4.11 ARBITRATION: To the extent applicable, the parties, in accordance with ARS §12-1518, agree to resolve all disputes arising out of or relating to this MOU through arbitration, after exhausting applicable administrative review except as may be required by other applicable statutes. This provision does not apply to provider claims disputes or member appeals regarding covered services provided by MIHS. 4 | P a g e 4.12 PUBLIC RECORDS: Notwithstanding any other provision of this MOU to the contrary, the Parities acknowledge that CHS is subject to A.R.S. 39-121 through 39-128 regarding public records. Any provision regarding confidentiality is limited to the extent necessary to comply with the provisions of Arizona law. 4.13 CONFIDENTIALITY OF RECORDS: 4.13.1 Each party agrees not use or disclose any PHI received from the other in any manner that would constitute a violation of this MOU or federal or state law. Each party shall take reasonable measures to ensure that its directors, officers, employees, vendors, contractors, and agents use or disclose PHI received from the other party in accordance with the provisions of this MOU and federal and state law. Each party further agrees to implement all appropriate safeguards reasonably necessary to maintain the confidentiality of the information accessed through the TechCare™ and EPIC systems, respectively. 4.13.2 The Parties acknowledge that before each of the Parties’ Authorized Users may have access to the other party’s electronic health records application system, Authorized Users may be required to read and agree to the terms of the respective party’s user/confidentiality agreement. Each party agrees to work cooperatively to fulfill this requirement and return copies of the executed agreements, as necessary. 4.13.3 MIHS acknowledges that it and its Authorized Users might be given access by CHS via TechCare™ to Criminal Justice Information for the sole purpose of safely and securely providing and/or coordinating treatment and/or healthcare services to patients incarcerated in the Maricopa County Jail. MIHS agrees that it will not use or disclose Criminal Justice Information for any other purpose, and will treat all Criminal Justice Information as confidential as required by state and federal laws at all times and take reasonable measures to maintain the security and confidentiality of such information. MIHS agrees to instruct its staff concerning the confidential nature of Criminal Justice Information and the applicable prohibitions against its use and disclosure. 4.13.4 REPORTING OF UNAUTHORIZED USE OR DISLOSURE OF PHI: CHS and MIHS shall, within twenty-four (24) hours of becoming aware or has reason to believe of an unauthorized use or disclosure of EPIC’s or TechCare™ PHI by either organization; or any of its Authorized Users, officers, directors, employees, vendors, contractors, agents or by a third party. Such notice shall be made to the following: 5 | P a g e MARICOPA COUNTY CORRECTIONAL HEALTH SERVICES (CHS) Attn: BIT Team Title: Address: 234 N Central Avenue, Suite 5350 City, State Zip: Phoenix, AZ 85004 Phone: (602) 506-0897 Email: CHSHIMTEAM@Maricopa.gov and CHSBIT@Maricopa.gov MARICOPA INTEGRATED HEALTH SERVICE Department: Chief Compliance Office Address: 2601 E. Roosevelt Street, 2nd Floor City, State Zip: Phoenix, AZ 85008 Phone: (602) 344-5915 Fax: Email: Copy To: Department: HIPAA HITECH Privacy Specialist Address: 2619 E. Pierce Street, 1st Floor City, State Zip: Phoenix, AZ 85008 Phone: Fax: Email: EHR.Access@mihs.org 4.14 ASSIGNMENT AND DELEGATION: 4.14.1 Neither party may assign this MOU without the express, written, prior consent of both parties, which shall not be unreasonably withheld or delayed. 4.14.2 This Agreement MOU does not imply authority to perform any tasks, or accept responsibility. 6 | P a g e 5. SECTIONS AND OTHER HEADINGS CONTAINED IN THIS MOU ARE FOR REFERENCE PURPOSES ONLY AND SHALL NOT AFFECT IN ANY WAY THE MEANINING OR INTERPRETATION OF THIS MOU: 5.1 This MOU may be executed in two or more counterparts, each of which shall be deemed an original but all of which together shall constitute the same instrument. Faxed, copied and scanned signatures are acceptable as original signatures. 5.2 ENTIRE MOU: This MOU contains the entire understanding of the parties hereto, and it supersedes all proposals, oral or written, and all other documents or communications between the parties relative to the subject matter herein covered, unless such documents or communications are specifically included by reference. 5.3 NOTICES: All notices under this MOU given by either party to the other shall be in writing and shall be delivered in person or sent by U.S. Postal Service, postage prepaid and addressed to the following individuals: MARICOPA COUNTY CORRECTIONAL HEALTH SERVICES (CHS) Attn: Tania Lynch Title: CHS Department Director Address: 234 N. Central Avenue, Suite 5000 City, State Zip: Phoenix, AZ 85004 Phone: (602) 372-4632 Email: tania.lynch@maricopa.gov MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT Attn: Sherry Stotler Title: Sr. VP and CNO Address: 2601 E. Roosevelt Street City, State Zip: Phoenix, AZ 85008 Phone: (602) 344-1215 Fax: Email: Sherry.Stotler@MIHS.org ACKNOWLEDGMENT: By signing below, MIHS and CHS each acknowledge their own respective role and responsibilities pursuant to this MOU. * Remainder of Page Intentionally Left Blank * 7 | P a g e WITNESS WHEREOF, the parties have executed this Agreement as of the respective dates written below. Maricopa County Special Health Care District MARICOPA COUNTY Authorized Individual: By: By: Name: Mark G. Dewane Name: Title: Chairman Title: Chairman, Board of Supervisors Date: Date: By: By: Name: Name: Title: MC CHS, Director Title: Clerk of the Board Date: Date: Approved as to Form: APPROVED AS TO FORM: By: __________________________ By: Title: Attorney for MIHS Name: Date: ______________________________ Title: Deputy County Attorney Date: Approved as to Form: By: ______________________________ Title: Attorney for CHS Date: ______________________________ 8 | P a g e