ARIZONA DEPARTMENT OF HEALTH SERVICES DATA SHARING AGR2015-045 .PDF

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Maricopa County Head
Start Zero-Five Program
DATA SHARING AGREEMENT
Data Sharing of Blood Lead Level Data between the Maricopa County Head
Start Zero-Five Program and the Arizona Department of Health Services Office
of Environmental Health
Maricopa County Head Start Zero-Five Program No.
ADHS Agreement No.
AGR2015-045
May 2015

MCHSP/ AGR2015-045
DSA for Arizona Childhood Lead Poisoning Prevention Program
1. TERM OF THE AGREEMENT:
The Term of this Agreement shall commence upon signature of both parties and shall continue for a
period of five (5) years, unless terminated, or canceled.
2. CONTRACT EXTENSION:
This Agreement may not be extended, and shall not exceed a total of five (5) years from the
effective date of the Agreement.
3. TERMINATION:
3.1 Either party may terminate this Agreement upon sixty (60) calendar day’s written notice to
the other Party or,
3.2 This Agreement remains in effect until terminated in accordance with Provision One (1) of
this section.
4. CONFIDENTIALITY:
4.1. Any information that may be exchanged through this Agreement shall not be used for
purposes other than those covered in the scope of work without prior approval of all parties
to this Agreement.
4.2. No personally identifying information that may be exchanged through this Agreement
shall be made available for any political or commercial purpose(s).
4.3. The Maricopa County Head Start Zero-Five Program (MCHSP) shall provide the names and
addresses of any individuals or entities outside of the MCHSP whom receive the data. The
MCHSP shall assure ADHS that the individuals or entities outside of the MCHSP will protect
the confidentiality and security of the data. The MCHSP shall monitor the individuals or
entities outside the MCHSP regarding the confidentiality and security of the data.
5. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT COMPLIANCE:
The MCHSP warrants that it is familiar with the requirements of HIPAA, as amended by the Health
Information Technology for Economic and Clinical Health Act (HITECH Act) of 2009, and
accompanying regulations and will comply with all applicable HIPAA requirements in the course of this
Agreement. The MCHSP warrants that it will cooperate with the Arizona Department of Health
Services (ADHS) in the course of performance of the Contract so that both ADHS and MCHSP will be
in compliance with HIPAA, including cooperation and coordination with the Arizona Department of
Administration-Arizona Strategic Enterprise Technology (ADOA-ASET) Office, the ADOA-ASET
Arizona State Chief Information Security Officer and HIPAA Coordinator and other compliance officials
required by HIPAA and its regulations. The MCHSP will sign any documents that are reasonably
necessary to keep ADHS and The MCHSP in compliance with HIPAA, including, but not limited to,
business associate agreements.
If requested by the ADHS Procurement Office, The MCHSP agrees to sign a “Pledge to Protect
Confidential Information” and to abide by the statements addressing the creation, use and disclosure
of confidential information, including information designated as protected health information and all
other confidential or sensitive information as defined in policy. In addition, if requested, The MCHSP
agrees to attend or participate in HIPAA training offered by ADHS or to provide written verification
that The MCHSP has attended or participated in job related HIPAA training that is: (1) intended to
make the MCHSP proficient in HIPAA for purposes of performing the services required and (2)
presented by a HIPAA Privacy Officer or other person or program knowledgeable and experienced in
HIPAA and who has been approved by the ADOA-ASET Arizona State Chief Information Security
Officer and HIPAA Coordinator.
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MCHSP/ AGR2015-045
DSA for Arizona Childhood Lead Poisoning Prevention Program
6. APPLICABLE LAW:
Arizona Law- Applicable law of Arizona applies to this Agreement including, where applicable, the
Uniform Commercial Code as adopted by the State of Arizona.
7. CONFLICT OF INTEREST:
Pursuant to A.R.S. §38-511, the State, its political subdivisions or any department or agency of either,
may, within three (3) years after its execution, cancel any Agreement, without penalty or further
obligation, made by the State, its political subdivisions, or any of the departments or of either entity if
any person significantly involved in initiating, negotiating, securing, drafting or creating the Agreement
on behalf of the State, its political subdivisions or any of the departments or agencies of either entity
is, at any time while the Agreement or any extension of the Agreement is in effect, an employee or
agent of 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. A cancellation made pursuant to this
provision shall be effective when both parties to this Agreement receive written notice of the
cancellation unless the notice specifies a later time.
8. ARBITRATION:
Pursuant to A.R.S. § 12-1518, disputes under this Agreement shall be resolved through the use of
arbitration as follows:
8.1. Cases under the Jurisdictional Limit. In all cases filed in superior court in which the court
finds or the parties agree that the amount in controversy does not exceed the jurisdictional
limit(s); arbitration shall be used, unless all parties file a written stipulation waiving the
arbitration requirement, and the court waives the arbitration requirement on a showing of good
cause.
9. FUNDING:
This Agreement is neither an obligation of, nor 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 confidential information related to the purposes of this Agreement. Expenditures by each 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.
10. INSURANCE:
The Arizona Department of Health Services and the MCHSP are self -insured for liability per A.R.S.
§41-621.
11. NON-DISCRIMINATION:
Both parties shall comply with Executive Order 2009-09, which mandates that all persons regardless
of race, color, religion, sex, age, national origin or political affiliation, shall have equal access to
employment opportunities, and all other applicable State and Federal employment laws, rules and
regulations, including the Americans with Disabilities Act. All parties shall take affirmative action to
ensure that applicants for employment and employees are not discriminated against due to race,
creed, color, religion, sex, national origin or disability.
12. AMENDMENTS
Any Amendments to this Agreement must be in writing and signed by both parties.
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MCHSP/ AGR2015-045
DSA for Arizona Childhood Lead Poisoning Prevention Program
13. SCOPE OF SERVICES:
Background and Purpose
Pursuant to the authority granted the Arizona Department of Health Services (ADHS) under Title
36, Chapter 13, Article 6 of the Arizona Revised Statutes, the Office of Environmental Health
(OEH), acting in capacity as a public health authority as that term is used in 45 C.F.R. 164.501,
reports blood lead data to the Centers for Disease Control and Prevention (CDC) annually. The
objective of this Agreement is to ensure accurate and complete reporting to the CDC by sharing
data between the MCHSP and ADHS.
Head Start Program offers early childhood education, nutritious meals and snacks, and medical
and dental services. It also provides social services for families, activities for parents,
assistance for children with special needs, and comprehensive child and family development
services.
The MCHSP are required to ensure all children receive lead screening according to the Arizona
Health Care Cost Containment System (AHCCCS) Early Periodic Screening, Diagnostic and
Treatment (EPSDT) Schedule in the first ninety (90) days enrolled in the Program. The Program
requires that all children received a blood lead test at age twelve (12) months and again at
twenty-four (24) months. Children between the ages of thirty-six (36) months and seventy-two
(72) months must receive a blood lead test if they have not been previously tested for blood
lead at the age of twenty-four (24) months or if they are found at risk of lead toxicity on a
questionnaire for lead exposure within ninety (90) days enrolled in the Program.
The ADHS and MCHSP continue to work collaboratively to implement actions to increase blood
lead screening and testing in enrolled participants, as well as to coordinate follow up testing and
family education as needed.
Sharing blood lead screening and testing data between ADHS and MCHSP will eliminate
repetitive testing of children, duplication of effort in implementing interventions, and also enable
both entities to identify barriers to eliminate blood lead poisoning such as:
13.1. Inadequate provider screening for blood lead in children
13.2. Persistent lead sources
13.3. Lack of family blood lead knowledge
The shared vision of MCHSP and ADHS includes:
13.4 Eliminate blood lead poisoning in children by 2020
13.5 Identify children with elevated blood lead levels to initiate early intervention and
treatment, when needed
14. DESCRIPTION OF SERVICES:
States are facing extraordinary reductions in budgets. Arizona and other states will be
challenged for the foreseeable future to meet goals for the health and well-being of its citizens
with very limited resources. Collaboration between the two organizations to compile current,
accurate data and join in efforts to increase monitoring will enhance the goal of eliminating
blood lead poisoning in Arizona’s children by 2020. Sharing data and interventions will eliminate
duplication of efforts, thereby improving cost containment.
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MCHSP/ AGR2015-045
DSA for Arizona Childhood Lead Poisoning Prevention Program
Providing ADHS with the name of the child allows MCHSP staff to ensure a child with elevated
blood lead levels receives treatment or intervention when appropriate and a child who is
considered low-risk, with previous non-elevated lead levels does not receive repetitive blood
lead screening.
MCHSP shares data with ADHS to identify children enrolled in the Program who have or have
not received a blood lead test. MCHSP coordinates blood lead testing to enrolled children if they
have not received a blood lead test. The results are reported to ADHS, if done using a point-of-
care blood lead testing system (e.g., LeadCare II). If MCHSP programs use an offsite, certified
laboratory, the MCHSP programs do not need to report blood lead levels to ADHS, as the
laboratory already reports to ADHS.
The following information is shared with ADHS:
14.1. MCHSP will provide parental/guardian consent documentation and the child’s name and date
of birth to ADHS for ADHS to confirm whether a child has received a blood lead test and to
provide the results of any blood lead test received by the child. The parental/guardian
consent documentation shall indicate that ADHS is authorized to release blood lead testing
results and test date for the child to MCHSP. The parental/guardian consent documentation
shall include the signature of the child’s parent/guardian and the date of signing.
14.2. MCHSP will report any blood lead test performed and analyzed onsite using a point-of- care
blood lead testing system by MCHSP if it is known or available:
14.2.1. Child name, address, and telephone number,
14.2.2. Child date of birth,
14.2.3. Child gender,
14.2.4. Funding source and the specific health plan name
14.2.5. Type of blood draw,
14.2.6. The date the blood was drawn,
14.2.7. The blood lead level,
14.2.8. The date the blood lead level was received by the physician or determined
by the laboratory,
14.2.9. The name, address, and telephone number of the laboratory that tested the
blood, and
14.2.10. The name, practice name, address, and telephone number of the physician
who ordered the test.
14.3. The ADHS will:
14.3.1. Upon receiving the request and signed parent/guardian consent agreement
from MCHSP, ADHS will inform MCHSP which children have received blood
lead screening and provide lead test results for children who have received
blood lead screening.
14.3.2. Provide messaging or educational materials for families and MCHSP staff
related to blood lead testing.
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MCHSP/ AGR2015-045
DSA for Arizona Childhood Lead Poisoning Prevention Program
14.3.3. Establish and maintain physical, technical, and administrative safeguards
consistent with 45 CFR. Part 164 regarding protected health information
provided to ADHS by MCHSP.
14.4. The MCHSP will:
14.4.1. Report blood lead screening performed by MCHSP, using a point-of-care
blood testing system, to ADHS.
14.4.2. Provide opportunities for ADHS to speak to MCHSP regarding the Arizona
Childhood Lead Poisoning Prevention Program.
15. RECORDS:
ADHS, pursuant to A.R.S. § 35-214, shall establish and maintain related to this Agreement, all books,
accounts, reports, files and other records relating to this Agreement for inspection and audit for
MCHSP, for a period of five (5) years after its completion. Upon request by MCHSP, a legible copy
of the original of all such records shall be produced by ADHS.
16. MISCELLANEOUS:
It is mutually agreed by the parties that:
16.1. Any amendments to this Agreement must be in writing and signed by both parties.
16.2. All requests for additional services shall be in writing and signed by both parties.
17. CORRESPONDENCE:
17.1. All programmatic correspondence pertaining to this Agreement shall be sent to the
parties respectively as follows:
For: Arizona Department of Health Services:
ADHS/OEH
Arizona Department of Health Services
Office of Environmental Health
ATTN: Brigitte Dufour, Office Chief
Bureau of Epidemiology and Disease Control
Phone Number: (602) 364-3142
Fax Number: (602) 364-3146
Email: Brigitte.Dufour@azdhs.gov
150 N 18th Avenue, Ste. 140
Phoenix, Arizona 85007
For: Maricopa County Head Start Zero-Five Program:
Alecia Jackson, M.Ed.
Director, Head Start Zero-Five Program
2150-1 S. Country Club Drive, Suite 7
Mesa, AZ 85210
Office: 480-464-9669 ext. 201
Email: jacksona002@mail.maricopa.gov
17.2. All notices pertaining to this Agreement shall be sent to the parties respectively as
follows:
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MCHSP/ AGR2015-045
DSA for Arizona Childhood Lead Poisoning Prevention Program
For: Arizona Department of Health Services:
Notices and Correspondence above
For: Maricopa County Head Start Zero-Five Program:
Notices and Correspondence above
18. SIGNATURES:
IN WITNESS THEREOF, the parties have executed this Agreement:
For ADHS:
Authorized Signature: __________________________________________
Print Name & Title: ______________________________________________
Date: _________________________________________________________
Approved By: Attested to:
MARICOPA COUNTY
_________________________________ ____________________________
Chairman, Board of Supervisors Clerk, Board of Supervisors
_______________________________ ___________________________
Date Date
This Agreement has been reviewed pursuant to Section §§ 11-251 and 11-951, et. seq., Arizona
Revised Statutes, by the under signed Deputy County Attorney who has determined that it is proper in
form and is within the power and authority granted under the laws of the State of Arizona.
APPROVED AS TO FORM: APPROVED AS TO FORM:
_________________________________ ________________________________
Maricopa County State of Arizona
Deputy County Attorney Assistant Attorney General
_________________________________ ________________________________
Date Date
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