AGREEMENT AMENDMENT RE HEALTH-E-ARIZONA SUBSCRIPTION WITH AHCCCS.PDF

Agreement Number Th14-0005-036
ARIZONA H EALTH CARE COST CONTAINMENT SYSTEM
Janice K. Brewer Thomas Betiach
Governor Director
AHCCCS
801 EAST JEFFERSON STREET
PHOENIX, ARIZONA 85034
Health-e-Arizona Plus (HEAplus) Subscription Agreement
Date: August 7, 2013
State Contact: Member Services
Arizona Health Care Cost Containment System Administration (AHCCCSA)
801 East Jefferson St.
Phoenix, AZ 85034
1. SUBSCRIBER SPECIFIC INFORMATION
Subscriber Name: Maricopa County Dept. of Public Health — Healthcare for the
Homeless
Subscriber Address: 220 S. 12th Avenue
Phoenix, AZ 85007
Agreement Contact Person, Phone and Email: Tresa Floyd
(same address as above)
602-372-2100
tresafloydfrriail,maricppa.pv
Billing Contact Person, Phone and Email; Jane E. Cochrane
(same address as above)
602-372-2109
janecochrarie@mail.rnaric2pA,griv
Set up Fee: $0.00
Subscription and Maintenance Fee:
Includes Transaction Fees) $100.00 per month for # 5-10 user seats
Plan A / Plan B Plan A
Organization type: AHCCCS Registered Medical Provider or Contractor (RahlA, Health Plan,
FQHC, Hospital, other clinic or medical provider).
Subscription Restrictions: The subscriber understands that this subscription is for:
Clinic: Subscriber's ambulatory services at all locations and for use in
eligibility screening for those facilities only.
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Agreement Number M14-0005-036
2. PAYMENT TERMS:
2.1 The set-up fee is due immediately upon execution of this agreement.
2.2 After the set-up fee is received, AHCCCS will reach out within thirty (30) days to schedule an
orientation. Training and access to the system will only be available after orientation.
2.3 Ongoing subscription fees shall commence on the 1 5t day of the month following execution of
this agreement.
2.4 If advanced payment has been given and an overpayment exists, a credit will be calculated
and added to your account.
2.5 The State reserves the right to suspend service if payment is not received within sixty (60)
days of invoice.
2.6 The Center to Promote Healthcare Access dba Social Interest Solutions (SIS) is the vendor
operating HEAplus on behalf of the State of Arizona and will send the subscriber invoices to
the "Billing Contact" listed on the front page of this agreement. Indicate below the
subscriber's preference of invoice/payment cycle:
El Monthly
Quarterly
n Semi - Annually
1=1 Annually
2.7 Submit Payment to:
Social Interest Solutions (SIS)
Director of Applications Solutions
1333 Broadway # 1020
Oakland, CA, 94612
3. TERM OF AGREEMENT
3.1 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.
3.2 Either party may cancel this agreement any time with thirty (30) days prior written notice.
The payment obligations of subscriber which had been incurred prior to the effective date of
termination shall continue in full force and effect notwithstanding the expiration or
termination of this Agreement and shall exist whether or not an invoice has been rendered.
4. SUBSCRIBER'S RESPONSIBILITIES
4.1 The subscriber shall abide by the following:
4.1.1 Provide information and services in a fair, accurate and impartial manner.
4.1.2 Provide information that is culturally and linguistically appropriate to the needs of
the population the subscriber 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.
4.1.3 The subscriber shall not charge a fee for completing HEAplus screening/application.
4.1.4 The subscriber shall manage user accounts and ensure that all credentials and
associated training are properly obtained and maintained for all users. The
subscriber shall terminate HEAplus accounts on or before the effective date of
termination for assisters or others who leave the employ or are no longer using
HEAplus.
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Agreement Number YH14-0005-036
4,15 The application shall be assisted by a person trained and authorized to input data.
4.1.6 All users shall go through identity proofing and multi-factor authentication to
obtain their credentials to use HEAplus.
4.1.7 The person with established credentials to use HEAplus shall not share their
credentials or otherwise disclose this information.
4.1.8 To respect client privacy, the subscriber shall not use a consumer's account
credentials for any purpose.
4,1.9 The persons with established credentials to use HEAplus shall attend and pass a
test provided by the State of Arizona relevant to security and privacy requirements.
This training and test shall be completed at the time the account credentials are set
and on an annual basis thereafter.
4,1.10 All persons who obtain an account in HEAplus shall read and acknowledge an end
user license agreement which sets forth the responsibilities included herein.
4.1.11 The subscriber shall ensure that every person it authorizes to input data has
participated in HEAplus training before using the system.
4.1.12 The subscriber shall submit completed applications, which includes submitting as
much of the required documentation with the application as subscriber could
obtain.
4.1.13 The subscriber may advise or assist the applicant in obtaining the required
documentation.
4.1.14 The subscriber shall obtain applicant signatures at the time of application.
4.1.15 HEAplus will provide a standard set of reports for the subscriber's organization.
Requests for additional data or reports must be approved by the State of Arizona.
4.2 Subcontractors:
4.2.1 If the subscriber wishes to subcontract with application assisters, prior approval by
the State of Arizona is required. The subcontractor must meet the same standards
under this agreement as agreed to by the subscriber.
4.2.2 No subcontract shall in any way relieve the subscriber of any responsibility for
performance of its duties,
4.3 Confidentiality of Applicant Information:
4.3.1 The subscriber shall not either during or after the performance of the services,
including consumer account credentialing required by this agreement, use or
disclose any information obtained during the course of the work required by this
agreement to any person other than as permitted by A.A.C. § R9-22-512 and 42 CFR
Part 431, Subpart F.
4,3.2 If a subscriber learns a consumer's HEAplus account credentials, the subscriber
cannot use the consumer's credentials for any purpose.
4.3.3 Before requesting and obtaining information regarding an individual from the
HEAplus, the subscriber shall obtain a written authorization signed by the individual
that complies with the requirements of the federal Health Privacy Rule, 45 C.F.R.
164.508. The subscriber may not obtain information from HEAplus except as
permitted under the terms of the signed authorization. The subscriber shall retain
the written authorization for six (6) years, and shall make all such authorizations
available for inspection by AHCCCS upon demand.
4.4 Ownership of Data
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Agreement Number M14-0005-036
4.4.1 Data shall be the property of the client and the organizations which submit the
data on the client's behalf and the Agencies to which the application is submitted
for processing.
4.4.2 SIS has no proprietary rights in any data or information furnished to it. SIS shall
have no liability whatsoever for any claim associated with subscriber's collection,
entry, or use of the data, or arising out of subscriber's use of the HEAplus software
system.
4.5 Account Administration:
4.5.1 The subscriber is responsible for designating at least one staff member to function
as a HEAplus Site Administrator. The Site Administrator is responsible for the
following duties related to account administration:
• Authorizing access to HEAplus for appropriate staff of the subscriber
organization by setting up user accounts.
O The HEAplus user must go through identity proofing and multi-
factor authentication to obtain their credentials to use HEAplus.
O The HEAplus user with established credentials to use HEAplus will
not share their credentials or otherwise disclose this information.
• Deactivating user accounts to prohibit staff access to HEAplus on or before
an HEAplus user:
o Leaves the subscriber's employment; or
o Is reassigned to a job function within the subscriber's organization
• that does not require access to HEAplus; or
o Is no longer using HEAplus.
• Reactivating accounts and resetting passwords for the subscriber's HEAplus
users, when necessary.
• Managing the organization's locations.
4.6 Account Security:
4.6.1 The subscriber 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
their own individual account.
• Users may not reveal their HEAplus credentials to anyone, at any time or
for any purpose.
• All persons who obtain an account in HEAplus will be required to read and
acknowledge an end user license agreement which sets for the
responsibilities included herein.
• 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.
4.7 Minimum Equipment and Software Requirements for Subscriber:
4.7.1 In order to use HEAplus the subscriber must have:
• High Speed Internet;
• Computers with 64 MB RAM or higher;
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Agreement Number YH14-0005-036
• Printers with at least 600x600 dpi;
• Fax machines with at least 300x300 dpi;
• Web browser (Internet Explorer 7.0 or higher); and
• Adobe Acrobat Reader software to view PDF images, version 5.0 or higher.
4.8 Training Requirements:
4.8.1 The subscriber shall ensure that all staff using HEAplus complete the following
training:
• All users: Security Training. All users of HEAplus shall complete security
training before using the system and are required to complete security
training annually thereafter.
• Site Administrators and Supervisors: Training in the responsibilities
associated with these roles and the use of the specific functions available in
HEAplus for persons with these security roles.
• Application Assistors and Supervisors: Application Assistor training.
Application Assistors and Supervisors shall complete this training before
assisting customers using HEAplus.
4.8.2 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.
4.9 System Requirements for Training:
4.9.1 Edearning training is provided through the TRAIN learning management system.
4.9.2 TRAIN minimally requires the following (which may be amended at any time):
• WEB BROWSER:
• Internet Explorer 7; or
• Chrome Version 12
• Other
• Javascript enabled
• Cookies enabled
S. SUBSCRIPTION INCLUSIONS
5.1 Set-up:
5.1.1 Set-up services include:
• The ability to use the licensed software to transmit applications for the
term of the agreement;
• Set up of facility accounts;
• Training Site Administrator(s) on the administrative functions of the
software;
• Training individual users; and
• Training subscribers when and how to contact the hosting facility for help
desk support.
5.2 Subscription and Maintenance:
5.2.1 Subscription and Maintenance services include:
• The range of user seats specified on page 1;
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Agreement Number YH14-0005-036
• All electronic application transactions for the subscriber;
• Electronic, voice and other signature capability;
• System updates;
6 Subscriber support:
o Web-based Subscriber support (Subscriber service, system
conventions and best practices and access to technical personnel at
the hosting facility); and
o HEAplus system issues; and
• Software upgrades for the licensed software in parity with upgrades that
are available to general HEAplus licensees. Connectivity to DES and
AHCCCS personnel and systems.
5.3 Transactions:
5,11 Transactions are defined as applications created.
5,3.2 Transactions services include:
• Basic field level edits;
• Eligibility determination and enrollment for all AHCCCS programs (e.g.,
AHCCCS, KidsCare, 551-MAO, Medicare Cost Sharing 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), Santa
Cruz Health Connection (SCHC); and some DES programs (e.g., Medicaid,
CHIP, Nutrition Assistance (SNAP or Food Stamps)); Temporary Assistance
to Needy Families (TANF or Cash) and also Percent of Federal Poverty Level
(FPL);
• 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.
6. SUBSCRIPTION EXCLUSIONS
6.1 The following services are not covered in this agreement:
6.1.1 Software programming for custom integration with, or electronic interface to the
subscriber's information system(s); and
6.1.2 Additional modules or capabilities not listed above unless released or made
generally available in subsequent enhancements for all HEAplus subscribers.
6.2 These services may be obtained at an additional cost.
6.3 Entering into this agreement does not preclude the organization or individual staff from
applying for or becoming Navigators for the Federally Facilitated Marketplace.
7. TERMS AND CONDITIONS
7.1 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.
"Subscriber Specific Information".
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Agreement Number YH14-0005-036
7.2 Arbitration: The Parties to this agreement agree to resolve all disputes arising out of or
relating to this agreement through arbitration, after exhausting applicable administrative
review, to the extent required by A.R.S. § 12-1518, except as may be required by other
applicable statutes (Title 41).
7.3 Confidentiality: The Subscriber 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 Subscriber also acknowledges it is a subcontractor for that
license and subject to all the terms and conditions of the license. Subscriber agrees that it
shall be bound by the SIS's standard "click-through" End User License Agreement which shall
appear on subscriber's computer screens whenever subscriber logs onto the HEAplus
software system.
All data in HEAplus is confidential. All of the Subscriber's staff should be advised and
appropriately educated on their responsibilities of handling confidential data. It is the
Subscriber's responsibility to educate and inform their HEAplus users. Should the customer
become aware of any breach or misuse of this confidential data, they should inform AHCCCS
at (602)417-4561 immediately of the nature of the breach or misuse, remedies taken and the
date the misuse occurred. In addition, the Subscriber 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 reported.
7.4 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 subscriber 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.
7.5 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.
7.6 Limitations: In no event will HEAplus be liable to Subscriber for any indirect, direct,
incidental, lost profits, consequential, special or exemplary damages, arising out of or in
connection with Subscriber'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. In no event shall HEAplus' total liability for any damages, direct or indirect, in
connection with the use of HEAplus' software, services and/or the licenses granted herein,
exceed the fees paid by Subscriber to HEAplus under this agreement for the prior twelve-
month term, whether such liability arises from any claim based upon agreement, warranty,
tort, including negligence or otherwise. The limitations listed herein are severable (to stand
independently) in the event that any of the foregoing provisions are found to be void.
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7.7 Non-Discrimination: The Subscriber shall comply with State Executive Order No. 99-4 arid all
other applicable federal and state laws, rules and regulations, including the Americans with
Disabilities Act.
7,8 Termination: If the HEAplus program terminates, or AHCCCS is no longer able or willing to
oversee the HEAplus program, as it now exists, and no other organization wishes to assume
oversight responsibilities for this program, after all debts are paid, any subscription fees left
will be returned to the subscribers using an algorithm based on the subscriber's fee structure
and the remaining sum. If another organization does assume oversight for the HEAplus
project, the funds would transfer with the project and there would be no refund.
The State may terminate the agreement due to the failure of the subscriber 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 subscriber.
7.9 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.
7.10 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.
7.11 Relationship of Parties: Access to the subscription service is offered by AHCCCS and SIS for
the convenience of the subscriber to assist the subscriber in achieving its goals and
objectives. It is entered into voluntarily and at the request of the subscriber. This
subscription agreement is not intended to and does not bind the subscriber to perform, or
assist in the performance, of any function or activity on behalf of AHCCCS or SIS. The
subscriber 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 subscriber shall not explicitly or
implicitly hold itself out to the public as a contractor, agent, or business associate of either
the AHCCCS or SIS.
7.12 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 subscriber are violations of the
agreement and of applicable law. Such changes, including unauthorized written Contract
Amendments shall be void and without effect.
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Agreement Number YH14-0005-036
IN WITNESS THEREOF, THE PARTIES AGREED AND ACCEPTED:
Subscriber AHCCCS
MARICOPA COUNTY DEPT OF PUBLIC HEALTH —
HEALTHCARE FOR THE HOMELESS AHCCCS
Signature: Signature:
Printed: Tresa Floyd Printed: Meggan Harley, CPPO, MSW
Title: Operations Supervisor Title: Procurement and Contracts Manager
Date: Date:
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IN WITNESS WHEREOF, the parties agree to enter into this Agreement:
FOR AND ON BEHALF OF
MARICOPA COUNTY
By
Chairman, Board of Supervisors
Date
ATTEST:
Clerk of the Board
Date
APPROVED AS TO FORM:
Deputy Attorney for Maricopa County
Date