YH18-0024-029 MARICOPA COUNTY 2017.DOCX

Agreement Number YH18-0024-029
Health-e-Arizona Plus (HEAplus) Community Partner Agreement
Date: September 1, 2017
State Contact: Division of Member Services
Arizona Health Care Cost Containment System Administration (AHCCCSA)
801 East Jefferson St.
Phoenix, AZ 85034
1. HEAplus COMMUNITY PARTNER INFORMATION
Name of Community Partner Organization: Maricopa County
Community Partner Organization’s Address: 301 W. Jefferson, 10th Floor
Phoenix, AZ 85003
Organization representative who will be signing Jennifer Hawkins
this agreement (Name, Phone number and Email Health Care Services Integration Administrator
address) : 602-506-1968
hawkinsj002@mail.maricopa.gov
Organization Type: State or Local Government
Agreement Restrictions: The Community Partner organization understands
that this agreement is for: Partner’s business
locations and for use in eligibility screening for these
locations only.
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Agreement Number YH18-0024-029
2. PURPOSE: This agreement establishes the criteria for an organization to have access to the Health-e-
Arizona plus (HEAplus) system as a HEAplus Community Partner. The HEAplus Community Partner’s
users have organization accounts in HEAplus that they use to create applications for their customers
who want to apply, renew benefits and report changes for Medicaid, Nutrition Assistance and Cash
Assistance. Some HEAplus Community Partners may also help customers apply for sliding-fee-scale
clinic programs and Community Access Programs. HEAplus Community Partners can only use HEAplus
at the request of and with written permission from their customers and thus are acting as agents of
their customers and are not an agents or business associates of AHCCCS. HEAplus Community
Partners have workload features in HEAplus to allow them to track the status of the applications they
submit on behalf of their customers and create reports of their activities.
3. DEFINITION OF TERMS:
3.1 Application Assistors: Staff of the HEAplus Community Partner organization who have
HEAplus organization accounts that enable them to complete and submit applications for
customers.
3.2 HEAplus Account Credentials: HEAplus account credentials are the User Name and Password
for a HEAplus user’s account.
3.3 Users: A user is a person who works for a HEAplus Community Partners organization and has
a HEAplus account.
3.4 Customer: A customer is a person who is applying for or receiving benefits of one or more of
the programs available through HEAplus.
4. TERM OF AGREEMENT
4.1 The effective date of this agreement shall be the date of last signature which, in most cases,
will be AHCCCS. The agreement shall continue until terminated or cancelled.
4.2 Either party may cancel this agreement any time with thirty (30) days prior written notice.
5. HEAPLUS COMMUNITY PARTNER’S RESPONSIBILITIES
5.1 The HEAplus Community Partner organization shall abide by the following:
5.1.1 Provide information and services in a fair, accurate and impartial manner.
5.1.2 Provide information that is culturally and linguistically appropriate to the needs of
the population the HEAplus Community Partner organization serves, including
individuals with limited English proficiency, and ensure accessibility to persons with
disabilities, including certain Federal civil rights laws, such as Title IV of the Civil
Rights Act of 1964 and Section 504 of the Rehabilitation Act of 1973.
5.1.3 The HEAplus Community Partner organization shall not charge a fee for completing
a HEAplus screening or application.
5.1.4 The HEAplus Community Partner organization must have a HEAplus Site
Administrator at all times, who is responsible for HEAplus account administration
for the organization’s users. The HEAplus Community Partner organization may
have multiple Site Administrators.
5.1.5 Ensure that every person it authorizes to have a HEAplus account completes all
required HEAplus training.
5.1.6 Allow only approved and authorized Assistors and Supervisors of Application
Assistors to enter customer data in HEAplus.
5.1.7 Persons with established credentials to use HEAplus shall not share their
credentials or otherwise disclose this information.
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5.1.8 All users who obtain an account in HEAplus shall read and acknowledge two click
agreements when they log into their HEAplus account: an end user software license
agreement and a Use of your Health-e-Arizona Plus (HEAplus) organization account
agreement. The HEAplus Community Partner organization is responsible for and
assumes all liability for each user’s compliance with these agreements.
5.1.9 Maintain confidentiality and privacy of customers’ information that is disclosed in
the process of applying for benefits consistent with the terms of the written
authorization to release protected health information that the user obtains from
the customer and this agreement.
5.1.10 The HEAplus Community Partner organization shall submit completed applications,
which includes submitting as much of the required documentation with the
application as the user could obtain.
5.1.11 The HEAplus Community Partner users may advise or assist the customer in
obtaining the required documentation.
5.1.12 The HEAplus Community Partner organization shall obtain the customer’s signature
on the application before submitting the customer’s application.
5.1.13 HEAplus will provide a standard set of reports for the HEAplus Community Partner
organizations. Requests for additional data or reports must be submitted to
HEAplus Operations and approved by the State of Arizona.
5.2 Subcontractors:
5.2.1 If the HEAplus Community Partner organization wishes to subcontract with
application assisters, disclosure of the contractors to the State of Arizona is
required. The subcontractor must meet the same standards under this agreement
as agreed to by the HEAplus Community Partner organization.
5.2.2 No subcontract shall in any way relieve the HEAplus Community Partner
organization of any responsibility for performance of its duties.
5.3 Confidentiality of Applicant Information:
5.3.1 The HEAplus Community Partner organization shall not either during or after the
performance of the services permitted by this agreement, including helping
customers create their own HEAplus accounts and customer account credentialing
required by this agreement, use or disclose any information obtained during the
course of the work permitted by this agreement to any person other than as
permitted by A.A.C. § R9-22-512 and 42 CFR Part 431, Subpart F.
5.3.2 If a HEAplus Community Partner organization learns a customer’s HEAplus account
credentials, the organization cannot use the customer’s credentials for any
purpose. If the organization learns a customer’s account credentials, the
organization must notify the customer to immediately change their password.
5.3.3 Before requesting and obtaining information regarding an individual from HEAplus,
the HEAplus Community Partner shall obtain written authorization (Consent for an
Assistor) signed by the customer that complies with the requirements of the
federal Health Privacy Rule, 45 C.F.R. 164.508. The HEAplus Community Partner
may not obtain information from HEAplus except as permitted under the terms of
the signed authorization. The HEAplus Community Partner organization shall retain
the written authorization for six (6) years, and shall make all such authorizations
available for inspection by AHCCCS upon demand. The HEAplus Community Partner
shall upload, fax or e-mail a copy of the signed form to the customer’s application
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Agreement Number YH18-0024-029
within 24 hours after the application is submitted. If the customer refuses to grant
permission to the HEAplus Community Partner organization, the HEAplus
Community Partner organization may not access the customer’s information in
HEAplus or submit a HEAplus application for the customer.
5.4 Ownership of Data:
5.4.1 Data shall be the property of the State of Arizona and the organizations which
submit the data on the customer’s behalf and the Agencies to which the application
is submitted for processing.
5.4.2 Social Interest Solutions (SIS) has no proprietary rights in any data or information
furnished to it. SIS shall have no liability whatsoever for any claim associated with
the HEAplus Community Partner organization’s collection, entry, or use of the data,
or arising out of the HEAplus Community Partner organization’s use of the HEAplus
software system.
5.5 Account Administration:
5.5.1 The HEAplus Community Partner organization’s designated HEAplus Site
Administrator is responsible for the following duties related to account
administration:
Completing Site Administrator training
Creating accounts for the HEAplus Community Partner organization’s users;
Ensuring that all HEAplus users complete all required HEAplus training.
Ensuring that all credentials and associated training are properly obtained and
maintained for all users.
Submitting both the Organization and Individual User Application forms to
AHCCCS to obtain account approval.
Deactivating user accounts to prohibit access to HEAplus organization accounts:
o On or before close of business on the date a user leaves the HEAplus
Community Partner organization’s employment; or
o When the user is reassigned to a job function within the organization that
does not require access to HEAplus; or
o When the user is no longer using HEAplus.
Submitting an Organization User Application form to AHCCCS immediately
following deactivation of a HEAplus account requesting the user be removed
from active status.
Reactivating disabled accounts and resetting passwords for the organization’s
HEAplus users, when necessary.
Maintaining accuracy of demographic information in HEAplus for all of the
organization’s locations where HEAplus activities are performed.
5.5.2 The HEAplus Community Partner organization’s Site Administrator is responsible
for completing the following steps to enable a user to have access to a the HEAplus
system:
Creating the user’s account;
Submitting to AHCCCS an Organization User Application listing the persons for
whom the organization is requesting account approval;
Submitting to AHCCCS an Individual User Application that has been completed
by each person listed on the Organization User Application;
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Providing users with instructions for accessing required HEAplus training; and
Ensuring that the user submits proof to AHCCCS of completion all required
HEAplus training.
5.6 Account Security:
5.6.1 The HEAplus Community Partner organization is responsible for maintaining the
security of HEAplus user accounts.
User accounts must accurately reflect the identity of the individual user.
Users are prohibited from sharing HEAplus accounts. Each user must have his or
her own individual account.
Users may not reveal their HEAplus credentials to anyone, at any time or for any
purpose.
Each user must complete electronic identity verification in the HEAplus system.
All persons who obtain an account in HEAplus shall read and acknowledge two click
agreements when they log into their HEAplus account: an end user software license
agreement and a Use of your Health-e-Arizona Plus (HEAplus) organization account
agreement. Each user is responsible to comply with the rules of behavior in these
agreements.
The persons with established credentials to use HEAplus will attend and pass a
test provided by the State of Arizona relevant to security and privacy
requirements. This training and test must be completed at the time the account
credentials are set and on an annual basis thereafter.
5.7 Minimum Equipment and Software Requirements for the HEA Plus Community Partner
Organization:
5.7.1 Minimum requirements are subject to change from time-to-time based on
technological changes. When possible, at least 30 days written notice will be
provided for significant changes. In order to use HEAplus the HEA Plus Community
Partner organization must have:
High Speed Internet;
Computers with 64 MB RAM or higher;
Printers with at least 600x600 dpi;
Fax machines with at least 300x300 dpi or scanners;
Web browser (Internet Explorer 9.0 or higher); and
Adobe Acrobat Reader software to view PDF images, version 5.0 or higher.
5.8 Training Requirements:
5.8.1 The HEAplus Community Partner organization shall ensure that all staff using
HEAplus complete the following training, as appropriate:
5.8.1.1 Security Training: All users of HEAplus shall complete security training
before initial HEAplus account approval, and are required to complete
security training annually thereafter.
5.8.1.2 Site Administrator Training: Site Administrators must complete this training
to learn about the responsibilities associated with their role.
5.8.1.3 New User Training: Application Assistors and Supervisors must complete this
training before AHCCCS approves their HEAplus accounts for initial log in.
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5.8.1.4 Hospital Presumptive Eligibility Training: This supplementary training is
required for all Assistors and Supervisors of Application Assistors assigned to
a hospital location that has a contract with AHCCCS to make Hospital
Presumptive Eligibility (HPE) decisions.
5.8.1.5 Inmate Application Training: This supplementary training is required for all
users from correctional facilities that submit pre-release applications or
applications for hospitalized inmates.
5.8.2 HEAplus Community Partner Organization users shall complete all additional
required training that may be required in the future.
5.8.3 The HEAplus Community Partner organization shall ensure participation in ongoing
training events that provide new or clarifying information related to the HEAplus
system and assisting customers with applications.
5.8.4 Training may be provided in person, by webinar, or through e-learning.
5.8.5 All users with access to Application Assistor functions in HEAplus shall meet any
licensing, certification or other standards that may be prescribed by the state or
federal government.
5.9 System Requirements for E-Learning Training:
5.9.1 E-learning training is provided through the TraCorp learning management system.
5.9.2 Required Equipment: High speed internet with a web browser.
5.9.3 Optional Equipment
5.9.3.1 Audio enabled computer with speakers or headphones so the learner can
use the audio features in the e-learning lessons
5.9.3.2 Connection to a printer so the learner can print desk aids available through
the e-learning lessons
6. HEAPLUS AGREEMENT INCLUSIONS
6.1 Set-up Services include:
6.1.1 The ability to use the licensed software to transmit applications for the term of the
agreement;
6.1.2 Set up of organization accounts;
6.1.3 Training Site Administrator(s) on the administrative functions of the software; and
6.1.4 Training individual users.
6.2 Maintenance Services include:
6.2.1 All electronic application transactions for the HEAplus Community Partner
organization;
6.2.2 Electronic, voice and other signature capability;
6.2.3 System updates;
6.2.4 HEAplus Community Partner support:
6.2.4.1 Web-based support from technical personnel at SIS, including the ability to
report HEAplus system issues; and
6.2.4.2 Community Partner Hotline access to report application processing issues;
6.2.5 Software upgrades for the licensed software in parity with upgrades that are
available to general HEAplus licensees; and
6.2.6 Connectivity to DES and AHCCCS personnel.
6.3 Transactions:
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6.3.1 Transactions are defined as applications created.
6.3.2 Transactions services include:
Basic field level edits;
Eligibility determination and enrollment for all AHCCCS programs (e.g., AHCCCS,
KidsCare, SSI-MAO, Medicare Savings Programs, Children’s Rehabilitative
Services, Arizona Long Term Care Services, Freedom to Work and others); sliding
fee schedule or medical discount programs, as are appropriate, including, Pima
Community Access Program (PCAP) and Santa Cruz Health Connection (SCHC);
Percent of Federal Poverty Level (FPL) for sliding fee scale programs; Nutrition
Assistance; and Cash Assistance.
Archiving all applications for online retrieval for at least 1 year. Data may be
transferred to permanent archive thereafter. HEAplus permanent archives are
kept to 3 years;
Electronic update of eligibility and enrollment by DES and AHCCCS;
Application status tracking;
Automated retrieval of application summaries and documentation; and
Electronic application submission and routing to DES and AHCCCS.
7. HEAPLUS AGREEMENT EXCLUSIONS
7.1 The following services are not covered in this agreement:
7.1.1 Software programming for custom integration with, or electronic interface to the
HEAplus Community Partner organization’s information system(s); and
7.1.2 Additional modules or capabilities not listed above unless released or made
generally available in subsequent enhancements for all HEAplus users.
7.2 Entering into this agreement does not preclude the organization or individual staff from
applying for or becoming Navigators for the Federally Facilitated Marketplace.
8. TERMS AND CONDITIONS
8.1 Agreement: A limited, non-exclusive access to AHCCCS’ sub-license for the right to use the
ASP product known as HEAplus and for use at the locations specified in paragraph 1. “HEAplus
Community Partner Information”.
8.2 Arbitration: In accordance with ARS § 12-1518, the parties to agree to resolve all disputes
arising out of or relating to this Contract through arbitration, after exhausting applicable
administrative review except as may be required by other applicable statutes.
8.3 Conflict of Interest: In accordance with A.R.S. § 38-511, State may within three years after
execution cancel the Agreement, without penalty or further obligation, if any person
significantly involved in initiating, negotiating, securing, drafting or creating the Agreement on
behalf of the State, at any time while the Agreement is in effect, becomes an employee or
agent or any other party to the Agreement in any capacity or a consultant to any other party
of the Agreement with respect to the subject matter of the Agreement.
8.4 Confidentiality: The HEAplus Community Partner organization acknowledges that this is
licensed software of which all rights to copy, use or otherwise distribute are covered in the
license given by SIS to AHCCCS, through a separate contract. The HEAplus Community Partner
organization also acknowledges it is a subcontractor for that license and subject to all the
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terms and conditions of the license. The HEAplus Community Partner organization agrees that
it shall be bound by the SIS’s standard “click-through” End User License Agreement which shall
appear on HEAplus Community Partner user’s computer screens whenever the user initially
logs onto the HEAplus software system or changes their password.
8.5 All data in HEAplus is confidential. All of the HEAplus Community Partner organization’s staff
shall be advised and appropriately educated on their responsibilities of handling confidential
data. It is the HEAplus Community Partner organization’s responsibility to educate and inform
their HEAplus users. Should the HEAplus Community Partner’s staff become aware of any
breach or misuse of this confidential data, they should inform AHCCCS by immediately sending
an email to HEAplusSecurityIncidents@azahcccs.gov describing the nature of the breach or
misuse, remedies taken and the date the misuse occurred. In addition, the HEAplus
Community Partner organization shall comply with and support all privacy and security
standards required by the Affordable Care Act (ACA). Appropriate follow up actions will be
determined based on the nature of the breach or misuse.
8.6 Indemnification: The parties to this agreement agree that the State of Arizona, its
departments, agencies, boards and commissions shall be indemnified and held harmless by
the HEAplus Community Partner organization for the vicarious liability of the State as a result
of entering into this agreement. However, the parties further agree that the State of Arizona,
its departments, agencies, boards and commissions shall be responsible for its own
negligence. Each party to this agreement is responsible for its own negligence.
8.7 Law: Each provision of law and any terms required by law to be in this agreement are a part
of this agreement as if fully stated in it. The law of Arizona applies to this agreement.
8.8 Limitations: In no event will HEAplus be liable to the HEAplus Community Partner
organization for any indirect, direct, incidental, lost profits, consequential, special or
exemplary damages, arising out of or in connection with HEAplus Community Partner
organization’s use or inability to use HEAplus’ software or services, the breach of any express
or implied warranty or condition, or otherwise, whether arising out of tort, including
negligence, agreement or otherwise, in connection with HEAplus’ software, services and/or
the licenses granted herein, even if HEAplus has been advised of the possibility of such
damages. The limitations listed herein are severable (to stand independently) in the event
that any of the foregoing provisions are found to be void.
8.9 Non-Discrimination: The HEAplus Community Partner organization shall comply with State
Executive Order No. 99-4 and all other applicable federal and state laws, rules and regulations,
including the Americans with Disabilities Act.
8.10 Termination: The State may terminate the agreement due to the failure of the HEAplus
Community Partner organization to comply with any term or condition of the agreement. The
State shall provide written notice of the termination and the reasons for it to the HEAplus
Community Partner organization.
8.11 Severability: The provisions of this agreement are severable. Any term or condition deemed
illegal or invalid shall not affect any other term or condition of the agreement.
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8.12 Choice of Forum: The parties agree that jurisdiction over any action arising out of or relating
to this contract shall be brought or filed in a court of competent jurisdiction located in the
State of Arizona.
8.13 Relationship of Parties: Access to the HEAplus service is offered by AHCCCS and SIS for the
convenience of the HEAplus Community Partner organization to assist the HEAplus
Community Partner organization in achieving its goals and objectives. It is entered into
voluntarily and at the request of the HEAplus Community Partner organization. This
agreement is not intended to and does not bind the HEAplus Community Partner
organization to perform, or assist in the performance, of any function or activity on behalf of
AHCCCS or SIS. The HEAplus Community Partner organization is not a contractor, agent, or
business associate (as that term is used in the federal Health Privacy Rule, 45 C.F.R. 160.103)
of AHCCCS or SIS. The HEAplus Community Partner organization shall not explicitly or
implicitly hold itself out to the public as a contractor, agent, or business associate of either
the AHCCCS or SIS.
8.14 Amendments: This agreement is issued under the authority of the Procurement Officer who
signed this agreement. The agreement may be modified only through a signed amendment.
Changes to the agreement directed by a person who is not specifically authorized by the
procurement officer in writing or made unilaterally by the HEAPlus Community Partner
organization are violations of the agreement and of applicable law. Such changes, including
unauthorized written Contract Amendments shall be void and without effect.
IN WITNESS THEREOF, THE PARTIES AGREED AND ACCEPTED:
Subscriber AHCCCS
Maricopa County AHCCCS
Signature: Signature:
Printed: Jennifer Hawkins Printed: Meggan Harley , CPPO, MSW
Title: Health Care Services Integration Administrator Title: Chief Procurement Officer
Date: Date:
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