IGA AMENDMENT MARICOPA 18-172583 12-21-17.DOCX

ARIZONA DEPARTMENT OF
HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT 150 N. 18th Avenue, Suite 260
Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Procurement Specialist
Contract No: ADHS18-172583 Amendment No. 3
HIV Care Services
Effective upon signature, it is mutually agreed that the Intergovernmental Agreement referenced is amended as follows:
All other provisions of this agreement remain unchanged.
CONTRACTOR SIGNATURE
Contractor Name Contractor Authorized Signature
Address Printed Name
City State Zip Title
CONTRACTOR ATTORNEY SIGNATURE This Intergovernmental Agreement Amendment shall be effective the
Pursuant to A.R.S. § 11-952, the undersigned public agency attorney date indicated. The Public Agency is hereby cautioned not to commence
has determined that this Intergovernmental Agreement is in proper any billable work or provide any material, service or construction under
form and is within the powers and authority granted under the laws of this IGA until the IGA has been executed by an authorized ADHS
the State of Arizona. signatory.
State of Arizona
Signed this ______ day of _______________________ 201_
Signature Date
Printed Name Procurement Officer
RESERVED FOR USE BY THE SECRETARY OF STATE
Attorney General Contract No. P0012014000078, which is an
Agreement between public agencies, has been reviewed pursuant to
A.R.S. § 11-952 by the undersigned Assistant Attorney General, who
has determined that it is in proper form and is within the powers and
authority granted under the laws of the State of Arizona.
Signature Date
Assistant Attorney General
Printed Name:
(Continued on Next Page)

ARIZONA DEPARTMENT OF
INTERGOVERNMENTAL AGREEMENT (IGA) HEALTH SERVICES
1740 W. Adams, Room 303
AMENDMENT Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Contract No: ADHS18-172583 Amendment No.3 Procurement Specialist
1. INTRODUCTION
The Arizona Department of Health Services (“ADHS”), Office of Disease Integration and Services Ryan White
Part B and AIDS Drug Assistance Programs, and the Maricopa County (“Maricopa County”) Ryan White Part A
Program, and the Maricopa County Special Health Care District dba Maricopa Integrated Health System
(“MIHS”) Ryan White Part C Program (collectively, “Parties to this Amendment”) amend their
Intergovernmental Agreement with this Data Sharing Amendment (“Amendment”) to facilitate their individual
obligations as Recipients of the U.S. Department of Health and Human Services, Health Resources and Services
Administration, Ryan White HIV/AIDS Program (“Ryan White Recipient(s)”).
2. RECITALS
A. ADHS and Maricopa County have IGA # ADHS18-172583 and ADHS18-172575 that allows Maricopa
County and ADHS to share Client Level Data to improve health outcomes for clients that receive services
from both Maricopa County and ADHS.
B. ADHS and MIHS have IGA #ADHS17-145508 that allows ADHS and MIHS to share aggregated and
de-identified client data to evaluate public health outcomes for people living with HIV and receiving
services at MIHS.
C. Maricopa County and MIHS have IGA # C-90-14-145-1 and a Business Associates Agreement which
allow Maricopa County and MIHS to share Client Level Datato improve health outcomes for clients that
receive services from both Maricopa County and MIHS.
D. This Amendment to the IGAs (ADHS-Maricopa County, and ADHS-MIHS) allows the three entities
(ADHS-Maricopa County-MIHS) to share among each other Client Level Data that the three entities
enter into CAREWare. This data sharing will provide mechanisms to evaluate and improve health
outcomes for HIV positive individuals that are served by the ADHS, Maricopa County and MIHS Ryan
White Programs.
3. DEFINITIONS as used in this Amendment, the terms listed below are defined as follows
A. Associate Personnel: Employees, agents, representatives, and members of the workforce whose services
may be used to satisfy obligations or terms under this Amendment.
B. CAREWare System: “CAREWare System” means the electronic health and social support services
information systems that are separately owned and maintained by ADHS or Maricopa County or MIHS
and that are used by Ryan White HIV/AIDS Program grant recipients and their providers to report year-
end Ryan White HIV/AIDS Services Report client-level data, and to monitor quality of care on a regular
basis.
C. Client Level Data: “Client Level Data” means the health information that is created or received by a
Covered Entity or Hybrid Entity and relates to the physical condition, mental health or other health
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ARIZONA DEPARTMENT OF
INTERGOVERNMENTAL AGREEMENT (IGA) HEALTH SERVICES
1740 W. Adams, Room 303
AMENDMENT Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Contract No: ADHS18-172583 Amendment No.3 Procurement Specialist
condition of an Individual, or to the provision of health care to the Individual (including but not limited to
the payment for such health care); and identifies or can be used to identify the Individual as defined at 45
CFR 160.103.
D. Covered Entity: “Covered Entity” shall generally have the same meaning as the term “covered entity”
at 45 CFR 160.103 for purposes of this Amendment.
E. Health Care: “Health Care” shall generally have the same meaning as the term “health care” at 45 CFR
160.103.
F. Health Care Provider: “Health care provider” shall generally have the same meaning as the term “health
care provider” at 45 CFR 160.103.
G. Health Information: “Health Information” means data, whether oral or recorded in any form or medium,
that is created or received by any party to this Agreement and that relates to the past, present, or future
physical or mental health or condition of an individual; the provision of health care to an individual; or
the past, present, or future payment for the provision of health care to an individual.
H. HIPAA Rules: “HIPAA Rules” shall mean the Health Insurance Portability and Accountability Act
(“HIPAA”) privacy regulations found at 45 CFR Parts 160 and 164.
I. Hybrid Entity: “Hybrid Entity” shall generally have the same meaning as “hybrid entity” at 45 CFR
164.103 and, for purposes of this Amendment, means the Arizona Department of Health Services.
J. Part A Program: “Part A Program” shall mean the Maricopa County Ryan White Part A Program and
its obligations and responsibilities as a Ryan White Recipient.
K. Part C Program: “Part C Program” shall mean the Maricopa Integrated Health System, Ryan White Part
C Program and includes its obligations and responsibilities as a Ryan White Recipient.
L. Personally Identifying Information: “Personally Identifying Information” means data about an
individual receiving Ryan White Services, including the identifiers listed in 45 CFR 514(2)(i) and in
Arizona Revised Statutes § 13-2001, that identifies the individual or which there is a reasonable basis to
believe the information can be used to identify the individual.
M. Public Health Authority: “Public Health Authority” shall generally have the same meaning as the term
“public health authority” at 45 CFR 164.502 and, for purposes of this Agreement, means the Arizona
Department of Health Services, including its obligations and responsibilities as a Ryan White Program
Recipient.
N. Ryan White Services: “Ryan White Services” generally means any health care, treatment, or other
services received by an individual or any payment for health care, treatment, or other services provided
by Ryan White Recipients.
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ARIZONA DEPARTMENT OF
INTERGOVERNMENTAL AGREEMENT (IGA) HEALTH SERVICES
1740 W. Adams, Room 303
AMENDMENT Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Contract No: ADHS18-172583 Amendment No.3 Procurement Specialist
O. Security Incident: “Security Incident” shall generally have the same meaning as the term “security
incident” at 45 CFR 164.306.
P. Treatment: “Treatment” shall generally have the same meaning as the term “treatment” at 45 CFR
164.502.
3. PURPOSE.
This Amendment defines the responsibilities and obligations of the Parties to this Amendment with regard to the
shared use of Client Level Data that is collected or created by any Party to this Amendment to manage, coordinate,
evaluate, or deliver Ryan White Services.
The Parties to this Amendment agree to share Client Level Data to better facilitate service delivery to individuals
receiving Ryan White Services across the state of Arizona, to decrease costs associated with managing health
care and treatment services across the state of Arizona, and to more efficiently fulfill their individual and
collective responsibilities and obligations as Ryan White Recipients.
Although the Parties own and maintain separate CAREWare Systems that will store some of the Client Level
Data that is the subject of this Amendment, each Party to this Amendment understands that Client Level Data
entered into the CAREWare System by each individual Party may be combined/integrated with Client Level Data
entered into the CAREWare System by other Parties, and therefore that the Client Level Data stored in the ADHS
CAREWare System is jointly owned by all Parties to this Amendment. The shared use of Client Level Data
among the Parties to this Amendment is predicated on mutual assurances that the Parties to this Amendment will
keep all Client Level Data confidential and secure to protect the privacy of individuals receiving Ryan White
Services, and that any uses or disclosures of Client Level Data will be for a purpose defined in this Amendment
and in accordance with the terms of this Amendment. Clients must sign an annual Release of Information that
allows for sharing of data between the parties and that Release of Information must be included in the client’s
CAREWare information.
ADHS is a HIPAA hybrid entity. ADHS has not designated the Office of Disease Integration and Services, its
Ryan White Part B Program, or its AIDS Drug Assistance Program as covered components. See 45 CFR 164.103
and 45 CFR 164.105. By agreeing to use or release Client Level Data in compliance with the HIPAA Rules for
purposes of this Amendment, ADHS does not intend to convert its Office of Disease Integration and Services, its
Ryan White Part B Program, or its AIDS Drug Assistance Program into covered components.
4. AUTHORITY TO SHARE DATA.
This Amendment #3 to this IGA between ADHS and Maricopa County (ADHS 18-172583) mirrors
Amendment #6 to the IGA between ADHS and Maricopa County (ADHS 17-172575) and the IGA between
ADHS and Maricopa Integrated Health System (ADHS 17-15508). The parties to those IGAs shall construe the
identical amendments to allow MIHS and Maricopa County to share the data contemplated by this Amendment
with ADHS irrespective of the Party who initially recorded the data. ADHS may share data in the same way
with MIHS and Maricopa County.
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ARIZONA DEPARTMENT OF
INTERGOVERNMENTAL AGREEMENT (IGA) HEALTH SERVICES
1740 W. Adams, Room 303
AMENDMENT Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Contract No: ADHS18-172583 Amendment No.3 Procurement Specialist
5. DATA SHARING AGREEMENTS.
Each Party to this Amendment is permitted to use or disclose Client Level Data:
A. As necessary and allowable to perform the functions, activities, or services related to that Party’s duties
and obligations as Ryan White Recipients, either individually or collectively, as defined in contracts with
Health Resources and Services Administration Ryan White HIV/AIDS Program.
B. As necessary and allowable for the proper management and administration of the Party to this Amendment
or to carry out legal responsibilities of the Party to this Amendment, including duties or obligations of
acting as a Health Care Authority or other governmental entity. Disclosures to third parties for such
purposes is allowable only if:
i. The disclosure is required by law; or
ii. Each Party to this Amendment secures written assurance from the receiving party that the receiving
party will: (a) maintain the confidentiality of Client Level Data; (b) use or disclose Client Level
Data only as required by law or for the purpose for which it was disclosed to the recipient; (c)
notify the Party to this Amendment of any breaches in the confidentiality of the Client Level Data;
and (d) has obtained approval by the client to share the information among the parties.
C. As allowable under 45 CFR 164, Subpart E, sections 501 through 514.
i. Each Party to this Amendment may use de-identified Client Level Data only if the data is (i) de-
identified pursuant to 45 CFR 164.514(b), and (ii) the Party to this Agreement maintains the
documentation required by 45 CFR 164.514(b).
ii. Each Party to this Amendment may aggregate Client Level Data.
D. In addition to the permitted uses or disclosures in subsection A, each Party to this Amendment that is a
covered entity pursuant to the HIPAA Rules is permitted to use or disclose Client Level Data as necessary
to perform duties and obligations as a covered entity under the HIPAA Rules, including:
i. Patient access to Client Level Data, pursuant to 45 CFR 164.524.
ii. Amendment of Client Level Data, pursuant to 45 CFR 164.526.
iii. Accounting of disclosures, pursuant to 45 CFR 164.526.
iv. Breach notification, pursuant to 45 CFR 164, Part D.
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ARIZONA DEPARTMENT OF
INTERGOVERNMENTAL AGREEMENT (IGA) HEALTH SERVICES
1740 W. Adams, Room 303
AMENDMENT Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Contract No: ADHS18-172583 Amendment No.3 Procurement Specialist
E. Each Party to this Amendment will implement and maintain appropriate safeguards and comply with 45
CFR Part 164, Subpart C to prevent any use or disclosure of Client Level Data not otherwise permitted by
this Amendment.
i. Each Party to this Amendment will individually implement administrative, physical and technical
safeguards to protect the confidentiality, integrity, and availability of any electronic Client Level
Data, if any, that the Party to this Amendment creates, receives, maintains, or transmits.
ii. Each Party will use encryption technology to render unsecured Client Level Data unusable,
unreadable, or indecipherable to unauthorized individuals and shall comply with the HIPAA Rule.
F. Each Party to this Amendment will report in writing to the other Parties about any use or disclosure of
Client Level Data not permitted by this Amendment or any suspected or confirmed security incident
involving the CAREWare System within five business days of learning of such use or disclosure.
i. The Party that uses or discloses Client Level Data in a manner not permitted by this Amendment
(“impermissible use”) shall be responsible for determining whether the impermissible use
constitutes a breach of information privacy or security under federal or state law (“breach”).
ii. If the impermissible use constitutes a breach, the Party that caused the breach shall be responsible
for the breach, including instituting any corrective actions required by federal or state law,
including timely reporting to any oversight agency and/or affected persons, mitigation steps, and
payment of monetary penalties.
G. Each Party to this Amendment will appropriately inform all of its Associate Personnel whose services
may be used to satisfy obligations under this Amendment, of the terms of this Amendment.
i. Each Party to this Amendment represents and warrants that the Associate Personnel are under legal
obligation, by contract or otherwise, sufficient to enable full compliance with the provisions of
this Amendment.
ii. Each Party to this Amendment represents and warrants that it will ensure that Associate Personnel
sign whatever agreements deemed necessary, to ensure Associate Personnel understand their
obligations to protect Client Level Data under this Amendment. Agreements may include, but are
not limited to, Business Associates Agreements and Statements of Confidentiality signed by
Associate Personnel.
H. Prior to sharing Client Level Data, each Party to this Amendment will use a Release of Information to
document the client’s consent to share Client Level Datawith the Parties in this Amendment.
i. Each Party to this Amendment will collect a client-signed Release of Information form for all
clients impacted by this Amendment.
ii. Client Release of Information forms must be signed at least annually.
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ARIZONA DEPARTMENT OF
INTERGOVERNMENTAL AGREEMENT (IGA) HEALTH SERVICES
1740 W. Adams, Room 303
AMENDMENT Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Contract No: ADHS18-172583 Amendment No.3 Procurement Specialist
iii. The Release of Information must be included in the client’s CAREWare information.
6. MISCELLANEOUS.
A. Term. The term of this Amendment shall begin on the date of the approval by the Maricopa County
Board of Supervisors and shall remain in effect unless terminated, canceled, or extended as otherwise
provided herein. As it relates to this Amendment, this term supersedes any similar terms in the IGAs
referenced in Section 4 of this Amendment.
B. Termination. Each Party to this Amendment shall have the right to terminate this Amendment by mailing
to the other Parties to this Amendment written notice of termination by certified mail, return receipt
requested, at least thirty (30) days prior to the termination date. This Amendment may be modified at any
time by mutual written Amendment in order to accommodate unforeseen circumstances by the authorized
representative of the respective parties. As it relates to this Amendment, this term supersedes any similar
terms in the IGAs referenced in Section 4 of this Amendment.
C. Effect of Termination. Upon termination of this Amendment for any reason, each Party to this
Amendment shall retain the Client Level Data necessary for the Party to this Amendment to perform its
duties and obligations as a Ryan White HIV/AIDS Program Recipient, HIPAA covered entity, or Public
Health Authority or other governmental entity, or to carry out its legal obligations. Each Party’s
obligations to maintain appropriate safeguards pursuant to Section 3.C of this Amendment shall remain in
full force and effect after the termination of this Amendment.
D. References. A reference in this Amendment to HIPAA Rules, the Privacy Standards, or the Security
Standards means the law or regulation in effect on the Effective Date or as subsequently amended, and for
which compliance is required.
E. Amendment. Each Party to this Amendment agrees to take the action necessary to amend this
Amendment from time to time so that each Party to this Amendment that is a covered entity may comply
with the HIPAA Rules. All Amendments must be in writing and signed by each Party to this Amendment.
F. Ambiguity. Any ambiguity in this Amendment shall be interpreted to permit compliance with the
HIPAA Rules.
G. Funding. This Amendment is not an obligation of or a commitment of funds, or a basis for a transfer of
funds, but rather a statement of understanding between the Parties concerning the sharing and use of Client
Level Data related to the purposes of this Amendment. Expenditures by any Party are subject to that
Party’s budgetary processes and to the availability of funds and resources pursuant to applicable laws,
regulations, and policies of the respective Parties. As it relates to this Amendment, this term supersedes
any similar terms in the IGAs referenced in Section 4 of this Amendment.
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ARIZONA DEPARTMENT OF
INTERGOVERNMENTAL AGREEMENT (IGA) HEALTH SERVICES
1740 W. Adams, Room 303
AMENDMENT Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Contract No: ADHS18-172583 Amendment No.3 Procurement Specialist
7. NOTICES
a. All notices or other communications by either Party to the other hereunder shall be in writing and shall
be deemed properly delivered (A) when received by the Party; or (B) three days after deposit in the
United States mail of such notice or communications to the Parties entitled hereto, registered or
certified mail, postage prepaid, to the Parties at the following address (or to such other addresses as
are designated in writing to all Parties):
To: Carmen Batista, HIV Care and Services Manager, Arizona Department of Health Services
Address: 150 N. 19th Avenue, Ste #130. Phoenix, AZ 85007
Phone Number: 602-364-3606
E-mail Address: Carmen.Batista@azdhs.gov
To: Eric Moore, Senior HIV Program Manager, Maricopa Integrated Health Systems
Address: 2601 E. Roosevelt. Phoenix, AZ 85008
Phone Number: 602-364-2632
E-mail Address: Eric.Moore@mihs.org
To: Rose Conner, Ryan White Part A Program Manager, Maricopa County
Address: 301 W Jefferson, Suite 3200. Phoenix, AZ 85003
Phone Number: 602-372-7091
E-mail Address: conner001@mail.maricopa.gov
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