AGREEMENT WITH COMMUNITY INFORMATION AND REFERRAL FOR HMIS.PDF

HMIS Partnership Agreement
This agreement is entered into on the _____th day of ________, 20__ between Community
Information and Referral Services, hereafter known as "CIR”, and Maricopa County
administered by the Human Services Department hereafter known as “Provider Agency”
regarding access and use of the Maricopa Homeless Management Information System, hereafter
known as the "Maricopa HMIS”.
I. Introduction
Maricopa HMIS, a shared homeless database, allows authorized Provider Agencies throughout
the geographic area of Maricopa County to input, use, and receive information concerning their
own clients and to share information, subject to agreements, on common clients.
Maricopa HMIS Goals include:
a) People who are homeless or are in need of homeless prevention assistance will receive
improved coordinated care / services.
b) Participating providers will improve their data collection and workflow with use of HMIS
c) Participating providers will use the HMIS to meet all current external homeless/homeless
prevention reporting requirements from HUD and non-HUD funding sources.
d) The community will have timely, credible, quality data about services and people who
are homeless or in threat of becoming homeless.
e) 100% of homeless providers will participate in the HMIS. (Excluding Domestic Violence
Providers)
f) HMIS will be user-friendly for providers
g) Community and provider agency stakeholders will have current accurate information
about HMIS implementation and data regarding homelessness in Maricopa County
CIR administers Maricopa HMIS, contracts for an agency to house the HMIS database central
server and coordinates Provider Agency access to the HMIS database. CIR shall protect
Maricopa HMIS data from accidental or intentional unauthorized modification, disclosure, or
destruction. Maricopa HMIS, when used correctly and faithfully, will improve knowledge about
1

homeless people--their services and service needs, and may result in a more effective and
efficient service delivery system.
II. Confidentiality
A. The Provider Agency will uphold relevant federal and state confidentiality regulations
and laws that protect client records and will only release confidential client records with
written consent by the client1, or the client's guardian2, unless otherwise provided for in
regulations or laws.
1. The Provider Agency will abide specifically by federal confidentiality regulations
as contained in the Code of Federal Regulations, 42 CFR Part 2, regarding
disclosure of alcohol and/or drug abuse records if applicable. In general terms, the
federal regulation prohibits the disclosure of alcohol and/or drug abuse records
unless disclosure is expressly permitted by written consent of the person to whom it
pertains or as otherwise permitted by 42 CFR Part 2. A general authorization for
the release of medical or other information is not sufficient for this purpose. The
Provider Agency understands the federal rules restrict any use of the information to
criminally investigate or prosecute any alcohol or drug abuse patients.
2. The Provider Agency will abide specifically, when applicable, with the Health
Insurance Portability and Accountability Act of 1996 (HIPAA) and corresponding
regulations passed by the Federal Department of Health and Human Services. In
general, the regulations provide consumers with new rights to control the release of
medical information, including the right: to give advance consent prior to
disclosures of health information; to see a copy of health records; to request a
correction to health records; to obtain documentation of disclosures of health
information; to obtain an explanation of privacy rights and to be informed about
how information may be used or disclosed. The current regulation provides
protection for paper, oral and electronic information.
3. The Provider Agency will abide by Arizona State Laws and Federal Laws related to
confidentiality and security of medical, mental health and substance abuse
information as found in Arizona Revised Statues Title 12, Arizona Revised Statutes
Title 36, 42 CFR Part 2 and other relevant statutes, rules and regulations as
applicable.
4. The Provider Agency will provide a verbal explanation of Maricopa HMIS and
arrange, when possible, for a qualified interpreter or translator for an individual not
literate in English or having difficulty understanding the consent form(s).
1 Anyone who receives services from a Provider Agency.
2 “Guardian” is anyone legally in charge of the affairs of a minor or of a person deemed incompetent, according to
and defined in Title 14 of the laws of the State of Arizona. All references to “client” in this Agreement also apply to
“client’s guardian.”
2

5. The Provider Agency will not solicit or input information from clients into
Maricopa HMIS unless specific information proves essential to provide services, to
develop reports and provide data, and/or to conduct evaluations and research.
Evaluation and research will only use de-identified client data except in the case
when the Provider Agency evaluates and researches its own clients. In all cases, the
Provider Agency shall maintain compliance with all state and federal laws
regarding research, evaluation and confidentiality of individual client identities.
6. The Provider Agency will not divulge any confidential information received from
the Maricopa HMIS to any organization or individual without proper written
consent by the client (or guardian where appropriate) unless otherwise permitted by
relevant regulations or laws.
7. The Provider Agency will ensure that every person issued a User Identification and
Password to the Maricopa HMIS will comply with the following:
a. Read and abide by this Partnership Agreement
b. Read and sign the HMIS Code of Ethics form3
c. Create a unique User I.D. and password; and will not share or reveal that
information to anyone by written or verbal means
8. The Provider Agency understands that individuals granted Agency Administrator
access within each agency must become a Designated Maricopa HMIS Agency
Administrator through specific training provided by the CIR. The Provider Agency
understands that all client information will be encrypted on a file server physically
located in a locked office with controlled access, at the offices of Bowman Systems,
LLC located at 333 Texas Street, Suite 300, Shreveport, Louisiana 71101.
9. The Provider Agency agrees to submit payments in a timely fashion to CIR for
annual HMIS User License fees in effect at the time of execution of the agreement.
CIR agrees to work with Provider Agency Administrators to reconcile any
discrepancies on annually generated User License Invoices.
B. The Provider Agency agrees to document a client’s (or guardian’s when appropriate)
understanding and consent to enter client information into a central database and the
reasons for this entry. Furthermore,
1. An individual client (or guardian) must give implied or informed client consent by
understanding and signing a consent form for the Provider Agency prior to the
Provider Agency sharing any client information to another agency.
2. The completed consent form provides:
3 See Code of Ethics form
3

a. Informed client consent regarding basic identifying client data to be entered
into a shared database
b. Release of non-confidential service transaction information to be shared for
report purposes.
c. Client release to authorize the sharing of basic client identifying information
among designated Maricopa HMIS Provider Agencies.
3. A client might deny authorization to share basic identifying information or other
specified information via Maricopa HMIS. The Client Profile section within
ServicePoint will be marked restricted. This allows only the entering Provider
Agency access to client information and precludes the ability to share information.
4. Each Provider Agency is responsible for ensuring that its staff and users comply
with the requirements for informed consent and client confidentiality.
5. The Provider Agency agrees to place all client consent forms related to Maricopa
HMIS in a file to be located at the Provider Agency's business address and that such
forms are made available to the CIR for periodic audits. The Provider Agency will
retain these Maricopa HMIS related consent forms for a period of five years upon
expiration, after which time the forms will be discarded in a manner ensuring un-
compromised client confidentiality.
6. The Provider Agency understands that in order to update, edit, or print a client's
record, the Provider Agency or SubProvider Agency must have on file current client
consent form.
The Provider Agency agrees to enter the minimum data required in the Maricopa
HMIS; however, this does NOT mean that a Provider Agency is required to share
client identifiable information. A client’s information may be restricted to overall
access when the client refuses to allow his/her name, social security number or
other personally identifiable information to be shared in the database.
7. The Provider Agency agrees to permit the Maricopa HMIS Project to initiate and
administer the following data share with all HMIS participating agencies. A listing
of participating agencies can be found on the Maricopa HMIS website at
www.211arizona.org/hmis.
Data will be shared for the purpose of coordinated assessment and service
coordination. The data shared will help decrease duplication of work between
participating organizations, increase the quality of the data being entered in HMIS,
decrease the intake processes for homeless clients, and provide a more client centric
data system. The data share will help the Continuum make clearer data based
decisions while performing a more efficient delivery of service.
4

The Provider Agency agrees to share Continuum determined data share elements
and Continuum determined coordinated assessment tools. A listing of the items
can be viewed on the Maricopa HMIS website at www.211arizona.org/hmis.
8. The Provider Agency can also sign a Memorandum of Understanding (MOU) with
other HMIS Providers in order to share additional data. The ability to share client
level data will help each Provider Agency from duplicating received services.
The addition of new data elements into the data share after the MOU is signed will
require written approval from each Provider Agency. An email will be sent by the
Maricopa HMIS Project to each Provider Agency to detail the changes to the data
share and request a return email to acknowledge the changes. This email response
will be sufficient documentation of approval.
III. Data Entry and/or Regular Use
A. User Identification and Passwords are not permitted to be shared among users.
B. If a Provider Agency has access to a client's basic identifying information, non-
confidential service transactions and confidential information and service records, it
will be generally understood that a client gave consent for such access. However,
before a Provider Agency can update, edit, or print such information, it must have
informed client consent in writing
C. Provider Agency will not enter any fictitious or misleading client data on an individual
or family in Maricopa HMIS.
D. The Provider Agency will not misrepresent the number of clients served or the type of
services / beds provided in Maricopa HMIS by entering known, inaccurate information
(i.e. Provider Agency will not purposefully enter inaccurate information on a new
record or to over-ride information entered by another agency).
E. The Provider Agency will enter information into Maricopa HMIS according to agency
and HMIS adopted standards and will strive for real-time, or close to real-time, data
entry. Real-time or close to real-time is defined by either immediate data entry upon
seeing a client, or data entry into Maricopa HMIS within one business day. This
assumes that the Provider Agency has sufficient computers available for all staff
performing data entry into Maricopa HMIS.
F. The Provider Agency understands that with a current standard Maricopa HMIS client
consent form on file, it can update, edit, and print a client's basic identifying
information.
G. Discriminatory comments by an employee, volunteer, or other person acting on behalf
of the Provider Agency based on race, color, religion, national origin, ancestry,
handicap, age, sex, and sexual orientation are not permitted in Maricopa HMIS.
5

Offensive language and profanity are not permitted in Maricopa HMIS. This does not
apply to the input of direct quotes by a client IF the Provider Agency believes that it is
essential to enter these comments for assessment, service and treatment purposes.
H. The Provider Agency will utilize the Maricopa HMIS for business purposes only.
I. The Provider Agency understands CIR will provide initial training and periodic updates
to that training to assigned Provider Agency staff about the use of Maricopa HMIS.
This information is to then be communicated to other staff using Maricopa HMIS
within the Provider Agency.
J. The Provider Agency understands CIR will provide a help desk with Technical-support
according to the following:
Help Desk will be provided between 8:00 a.m. to 5:00 p.m. Arizona Time. Support
telephone numbers and email addresses will be provided to Provider Agencies upon
signing this Agreement. CIR will ensure that any support calls are responded to
according to the Severity Code Response Time, provided that all available numbers and
e-mail addresses have been accessed. Contact with the Help Desk will not incur any
long distance charges.
In the event of non-response the Provider Agency should notify the System
Administrator at CIR.
K. The Provider Agency will keep updated virus protection software on agency computers
that access Maricopa HMIS4.
L. Transmission of material in violation of any United States federal or state law or
regulation is prohibited and includes, but is not limited to: copyright material, material
legally judged to be threatening or obscene, and material considered protected by trade
secret.
M. The Provider Agency will not use Maricopa HMIS with intent to defraud the federal,
state or local government or an individual entity, or to conduct any illegal activity.
N. The Provider Agency acknowledges that other agencies will periodically have access to
de-identified data on the central database. To ensure the information generated by or
through Maricopa HMIS presents an accurate picture of homelessness and services to
homeless people in Maricopa region, the Provider Agency will enter data in a timely
and accurate manner.
O. Each Provider Agency assumes responsibility for (its) staff and users’ compliance in
regards to requirements for data entry and use of Maricopa HMIS. To assess the
4 Provider Agency assumes financial responsibility for virus protection software.
6

quality of data and reports generated by the system, CIR5 will conduct periodic
monitoring and reviews on data. These include and are not limited to the following:
1. Quality of data entered by Provider Agency
a. Inappropriate and/or duplicate records
b. Untimely and/or inaccurate information
c. Missing required data elements
2. Operation of the software
3. Reporting functionality
P. Provider Agency’s must notify CIR in writing of any changes to User ID including, but
not limited to, new personnel, and released or terminated personnel.
IV. Reports
A. The Provider Agency understands that it will retain access to all identifying and
statistical data on the clients it serves.
B. The Provider Agency understands that it may have access to personally identifiable
client information even if the Provider Agency has not served the client. The Provider
Agency agrees to not report or release any identifiable client information on clients
that the Provider Agency has not served.
C. The Provider Agency will run its own reports from Maricopa HMIS. Each Provider
Agency will receive required training and then have the ability to complete each
Provider Agency’s reporting needs.
V. Proprietary Rights and Database Integrity
A. The Provider Agency and CIR understand Maricopa HMIS and CIR are custodians of
data, and not owners of data. The database is jointly owned by the Provider Agency
and the Continuum of Care Regional Committee on Homelessness.
1. In the event Maricopa HMIS ceases to exist, CIR will notify Provider Agencies and
provide a six month time period for the Provider Agencies to access and save
specific client data, statistical data and frequency data from the entire system.
Then, the centralized server database will be purged or stored. If the latter occurs,
the data will remain in an encrypted and aggregate state.
2. In the event CIR ceases to operate Maricopa HMIS, another organization will
administer and take custodianship of the data. The CIR or its successor Agency will
inform, in a timely manner, all Provider Agencies.
5 CIR may conduct these reviews or may accept a similar review by another organization as evidence of compliance
by the Provider Agency.
7

3. If the Provider Agency ceases to exist, it shall notify and work with CIR to
determine the appropriate disposition of Provider Agency’s data, including the
transfer of the data to a successor agency.
4. If the Provider Agency chooses to withdraw from Maricopa HMIS, the Provider
Agency shall notify CIR of intended withdrawal date. CIR shall allow sixty days for
the Provider Agency to access and save agency specific client data, statistical data
and frequency data from the entire system. The Provider Agency is financially
responsible for extracting its data.
B. The Provider Agency will not give or share assigned user identification and passwords
to access Maricopa HMIS with any other organization, governmental entity, business,
or individual.
C. The Provider Agency will not cause in any manner, or way, corruption of Maricopa
HMIS. Any unauthorized access or unauthorized modification to computer system
information or interference with normal system operations, whether on the equipment
housed by CIR or any computer system or network related to Maricopa HMIS will
result in immediate suspension of services and CIR will pursue all appropriate legal
action.
D. The CIR6 will ensure and conduct periodic monitoring and reviews with Provider
Agencies to enforce informed and implied consent standards, HUD Standards, and
Continuum of Care Regional Committee on Homelessness Standards including:
1. Appropriate documentation indicating client awareness and consent of data being
entered into central database
2. Consent to release certain information.
3. Appropriate entry of universal and programmatic data elements as defined by HUD
4. Adherence to HMIS Policies and Procedures including Security Standards.
VI. Hold Harmless
A. CIR makes no warranties, expressed or implied. The Provider Agency, at all times,
will indemnify and hold CIR harmless from any damages, liabilities, claims, and
expenses that may be claimed against CIR or the Provider Agency, or for injuries or
damages to CIR or the Provider Agency arising from Provider Agency’s participation
in Maricopa HMIS, or arising from any acts, omissions, neglect or fault of the Provider
Agency or its agents, employees, licensees, or clients, or arising from the Provider
Agency’s failure to comply with laws, statutes, ordinances or regulations applicable to
it or the conduct of its business. CIR shall not be liable to the Provider Agencies for
damages, losses, or injuries to the Provider Agencies or another party unless such is the
result of negligence or willful misconduct of CIR or its agents, employees, licensees or
clients.
6 The CIR may conduct these reviews or may accept a similar review by another organization, designated by CIR ,
as evidence of Provider Agency compliance.
8

B. The Provider Agency makes no warranties, expressed or implied. CIR, at all times, will
indemnify and hold the Provider Agency harmless from any damages, liabilities,
claims, and expenses that may be claimed against CIR or Provider Agency, or for
injuries or damages to CIR, the Provider Agency, or another party arising from
participation in Maricopa HMIS, or arising from any acts, omissions, neglect, or fault
of CIR or its agents, employees, licensees, or clients, or arising from CIR’s failure to
comply with laws, statutes, ordinances or regulations applicable to it or the conduct of
its business. Thus CIR will also hold the Provider Agency harmless for negative
repercussions resulting in the loss of data due to delays, non-deliveries, mis-deliveries,
or service interruption caused by CIR or a Provider Agency’s negligence or errors or
omissions, as well as natural disasters, technological difficulties, and/or acts of God.
The Provider Agency shall not be liable to CIR for damages, losses, or injuries to CIR
or another party unless such is the result of negligence or willful misconduct of the
Provider Agency or its agents, employees, licensees or clients.
C. The Provider Agency agrees to keep in force a comprehensive general liability
insurance policy with combined single limit coverage of not less than one million
dollars ($1,000,000). Said insurance policy shall include coverage for theft or damage
of the Provider Agency’s Maricopa HMIS-related hardware and software.
VII. CIR Responsibilities
A. CIR agrees to enter into a contract and maintain the services of the ServicePoint
software according to the terms and conditions of the contract with the Software
Provider.
B. CIR agrees to maintain a Project Manager who will provide training, implementation,
help desk and support to the Provider Agency and SubProvider Agencies.
VIII. Dispute Resolution and Appeals
A. If the Provider Agency disagrees with any element of this Agreement it shall make
every effort to address and resolve those issues with the Chief Executive Officer of the
CIR.
B. If CIR and the Provider Agency are unable to reach a solution, either party may raise
the issue to the HMIS Advisory Board for a solution.
C. The HMIS Advisory Board will make every effort to resolve the issue; however, if the
issue cannot be adequately resolved at this level, the HMIS Advisory Board shall
recommend a process to reach resolution.
9

IX. Terms and Conditions
A. The parties hereto agree that this Agreement is the complete and exclusive statement of
the agreement between parties and supersedes all prior proposals and understandings,
oral and written, relating to the subject matter of this Agreement.
B. Neither party shall transfer or assign any rights or obligations without the written
consent of the other party.
C. The exception to this term is if allegations, or actual incidences, arise regarding possible,
or actual, breeches of this agreement. Should such situation arise, the CIR may
immediately suspend access to the Maricopa HMIS until the allegations are resolved in
order to protect the integrity of the system.
1. When the CIR becomes aware of a possible or actual incident, it shall make a
reasonable effort to address its concerns with the Executive Director of the Provider
Agency prior to taking action.
2. If CIR believes that the breech by a Provider Agency is such that it may damage the
integrity of the central database and the information in the central database for the
Provider Agency or any other Agency, it may take immediate steps to suspend the
Provider Agency’s access to HMIS prior to addressing the concerns with the
Director of the Provider Agency. CIR will then address the concern with the
Director of the Provider Agency to resolve the issue.
3. Action with a Provider Agency may include the provision of training and technical
assistance, fines, suspension of access to the central database or other appropriate
measures to ensure that the data integrity is maintained.
D. If a Provider Agency believes that action taken is not appropriate, or it cannot meet the
conditions of the decision, it may appeal the action to the HMIS Advisory Board. If the
Advisory Board and the Provider Agency cannot reach agreement, a representative of
the Advisory Board, CIR and Provider Agency shall address the issue before the
Continuum of Care Regional Committee on Homelessness. Decisions by the
Continuum of Care Regional Committee on Homelessness are final; however, every
attempt will be made by all parties to reach a reasonable accommodation for the
Provider Agency.
E. This agreement may be modified or amended by written agreement executed by both
parties with 30 days advance written notice.
10

F. Use of Maricopa HMIS constitutes acceptance of these Terms and Conditions.
IN WITNESS WHEREOF, the parties have executed this Agreement on the year and day first
above written.
COMMUNITY INFORMATION AND
REFERRAL SERVICES
(Signature)
Title
Date
MARICOPA COUNTY
(Signature)
Steve Chucri, Chairman Maricopa County Board of Supervisors
Title
Date
Approved as to Form:
Maricopa County Deputy Attorney
Date:
Attested To:
Maricopa County Clerk of the Board
Date:
11