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HomeMy WebLinkAboutAgreement_General_10/13/2022_NCSPlus TEQUESTA FIRE RESCUE(TFR) * .10 * APa+ FORM 25: Business Associate Agreement Business Associate Agreement Between Covered Entity and Business Associate This agreement is entered into by and between the Village of Tequesta, Department of Fire Rescue and NCSP)us hereafter referred to as"Business Associate" to set forth the terms and conditions under which "protected health information" (PHI), as defined by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and Regulations enacted hereunder, created or received by the Village of Tequesta, Department of Fire Rescue may be used or disclosed. This Agreement shall commence on (MM/DD/YY) 9 Z 2--and the obligations herein shall continue in effect so long as the Busines Ass ciate uses, discloses, creates or otherwise possesses any protected health information created or received on behalf of the Village of Tequesta, Department of Fire Rescue and until all protected health information created or received by the Business Associate on behalf of the Village of Tequesta, Department of Fire Rescue is destroyed or returned to the Village of Tequesta, Department of Fire Rescue pursuant to Paragraph 15 herein. 1) The Village of Tequesta, Department of Fire Rescue and the Business Associate hereby agree that the Business Associate shall be permitted to use and/or disclose protected health information created or received on behalf of the for the following purposes: a) Completing and submitting health care claims to health plans, Clearinghouses, and other third party payer. b) Collection of fees for the Village of Tequesta, Department of Fire Rescue. c) Establishing and maintaining Business Management Programs for the Village of Tequesta, Department of Fire Rescue. d) Introducing, maintaining, and programming Electronic Medical Record Systems for the Village of Tequesta, Department of Fire Rescue. e) Introducing, maintaining, and programming Electronic Medical Record Systems for the Village of Tequesta, Department of Fire Rescue. f) Introducing, maintaining, and programming compatible Dictation Systems for the Village of Tequesta, Department of Fire Rescue. It is to be understood by all parties that the permitted uses and disclosures must be within the scope of and necessary to achieve,the obligations and responsibilities of the Business Associate in performing on behalf of, or providing services to the Village of Tequesta, Department of Fire Rescue. 2) The Business Associate may use and disclose protected health information created or received by the Business Associate on behalf of Village of Tequesta, Department of Fire Rescue if necessary for the proper management and administration of the Business Associate or to carry out legal responsibilities, provided that any disclosure is: a) Required by law,or b) The Business Associate obtains reasonable assurances from the person to whom the protected health information is disclosed that: i. The protected health information will be held confidentially and used or further disclosed only as required by law or for the purpose for which it was disclosed to the person;and ii. The Business Associate will be notified of any instances of which the person is aware in which the confidentiality of the information is breached. 3) The Business Associate hereby agrees to maintain the security and privacy of all protected health information in a manner consistent with Florida State and Federal Laws and regulations including the Health Insurance Portability and Accountability Act of 1996 ("HIPAA")and regulations hereunder,and all other applicable law. 4) The Business Associate further agrees not to use or disclose protected health information except as expressly permitted by this Agreement, applicable law, or for the purpose of managing the Business Associate's own internal business processes consistent with Paragraph 2 herein. 5) The Business Associate shall not disclose protected health information to any member of its workforce unless the Business Associate has advised such person (employee) of the Business Associate's privacy and security obligations and policies under this Agreement, including the consequences for violation of such obligations. The Business Associate shall take appropriate disciplinary action against any member of its workforce who uses or discloses protected health information in violations of this Agreement and applicable law. 6) The Business Associate shall not disclose protected health information created or received by the Business Associate on behalf of Village of Tequesta, Department of Fire Rescue to a person, including any agent or subcontractor of Business Associate but not including a member of Business Associate's own workforce, until such person agrees in writing to be bound by the provisions of the Agreement and applicable Florida State or Federal Law. 7) The Business Associate agrees to use appropriate safeguards to prevent use or disclosure of protected health information not permitted by this Agreement or applicable laws. 8) The Business Associate agrees to maintain a record of all disclosures of protected health information, including disclosures not made for the purposes of this Agreement. Such record shall include the date of the disclosure,the name and, if known,the address of the recipient of the protected health information, the name of the individual who is the subject of the protected health information, a brief description of the protected health information disclosed, and the purpose of the disclosure. 14511' aer 9) The Business Associate agrees to report to the Village of Tequesta, Department of Fire Rescue's privacy officer any unauthorized use or disclosure of protected health information by the Business Associate or its workforce or subcontractors and the remedial action taken or proposed to be taken with respect to such use or disclosure. 10) The Business Associate agrees to make its Internal practices, books, and records relating to the use and disclosure of protected health information received from the Village of Tequesta, Department of Fire Rescue or created or received by the Business Associate on behalf of the Village of Tequesta, Department of Fire Rescue, available to the Secretary of the United States Department of Health and Human Services, for purposes of determining the Covered Entity's compliance with HIPAA. 11) Within thirty(30)days of a written request by the Village of Tequesta, Department of Fire Rescue,the Business Associate shall allow a person who is the subject of protected health information, such person's regal representative, or the Village of Tequesta, Department of Fire Rescue to have access to and to copy such person's protected health information in the format requested by such person, legal representative, or practitioners unless it is not readily producible in such format, In which case it shall be produced in standard hard copy format. 12) The Business Associate agrees to amend,pursuant to a request by the Village of Tequesta, Department of Fire Rescue, protected health information maintained and created or received by the Business Associate, on behalf of Village of Tequesta, Department of Fire Rescue. The Business Associate further agrees to complete such amendment within thirty(30) days of a written request by the Village of Tequesta, Department of Fire Rescue,and to make such amendment as directed by the Village of Tequesta,Department of Fire Rescue. 13) In the event the Business Associate fails to perform the obligations under this Agreement, the Village of Tequesta, Department of Fire Rescue may, at its option: a) Require the Business Associate to submit a plan of compliance, including monitoring by the Village of Tequesta, Department of Fire Rescue any reporting by the Business Associate, as Village of Tequesta, Department of Fire Rescue, in its sole discretion, determines necessary to maintain compliance with this Agreement and applicable law. Such plan shall be incorporated Into this Agreement by amendment hereto:and b) Require the Business Associate to mitigate any loss occasioned by the unauthorized disclosure or use of protected health information. c) Immediately discontinue providing protected health information to the Business Associate with or without written notice to the Business Associate. 14) The Village of Tequesta, Fire Rescue Department may immediately terminate this Agreement and related agreements if the Village of Tequesta, Department of Fire Rescue determines that the Business Associate has breached a material term of this Agreement. Alternatively,the Village of Tequesta, Department of Fire Rescue may choose to: 146 ) Page a) Provide the Business Associate with ten (10) days written notice of the existence of an alleged material breach; and b) Afford Business Associate an opportunity to cure said alleged material breach to the satisfaction of the Village of Tequesta, Department of Fire Rescue within (10) days. The Business Associate's failure to cure shall be ground for immediate termination of this agreement. The Village of Tequesta, Department of Fire Rescue remedies under this Agreement are cumulative,and the exercise of any remedy shall not preclude the exercise of any other. 15) Upon termination of this Agreement, the Business Associate shall return or destroy all protected health information received from Village of Tequesta, Department of Fire Rescue, or created or received by the Business Associate on behalf of the Village of Tequesta, Department of Fire Rescue and that the Business Associate maintains in any form, and shall retain no copies of such information. If the parties mutually agree that return or destruction of protected health information is not feasible, the Business Associate - shall continue to maintain the security and privacy of such protected health information in a manner consistent with the obligations of this Agreement and as required by applicable law, and shall limit further use of the information to those purposes that make the return or destruction of the information infeasible. The duties hereunder to maintain the security and privacy of protected health information shall survive the discontinuance of this Agreement. lb) The Village of Tequesta, Department of Fire Rescue may amend this Agreement by providing ten (10)days prior written notice to the Business Associate in order to maintain compliance with Florida State or Federal Law. Such amendment shall be binding upon the Business Associate at the end of the ten (10) day period and shall not require the consent of the Business Associate. The Business Associate may elect to discontinue the Agreement within the ten (10) day period, but the Business Associate duties hereunder to maintain the security and privacy of protected health information shall survive such discontinuance. The Village of Tequesta, Department of Fire Rescue and the Business Associate may otherwise amend this Agreement by mutual written agreement. 17) The Business Associate shall, to the fullest extent permitted by law, protect, defend, indemnify and hold harmless Village of Tequesta and the Department of Fire Rescue,and his/her respective employees,directors, and agents("Indemnities') from and against any and ali losses,costs, claims, penalties, fines,demands,liabilities, legal actions,judgments, and expenses of every kind (including reasonable attorneys fees, including at trial and on appeal) asserted or imposed against any Indemnities arising out of the acts or omissions of the Business Associate or any of the Business Associate's employees, directors or agents related to the performance or nonperformance of this Agreement. 18) In the event of a conflict between this Business Associate Agreement and Section 14 of the Master Services Agreement,the provisions of this Business Associate Agreement shall control. 1,17I agc 1 \ \ S ) -.Vk On Behfalf of - illage of Teque. Dale Depatt, - •' Fire Resc ifilliAtif 9,/zo/e fldor Name) I4S I COMPLETE AND MAIL TO: SERVICE AGREEMENT NCSPLUS Incorporated Client(System)Number i ReportOrder Today's Date Vyvfw•nCsplUs.COm DA ON JULY 28 2022 Order Department Initial Password Type of Business No.Z 117 Eras',24th St,5th Floor 1.TequrgoaFierice MunicipalityNew York,NY 10010 Now Order I Reorder Rewrite Print Trans. oyes Tetepoone Cells Yes Telephone:212.213.3000 X I O No I to NCS(Primary) Olio Fax: 212-213-3320 CLIENT NAME VILLAGE OF TEQUESTA w pooREss345 TEQUESTA DRIVE ADDRESS(2) _. -__-'--______— CITY._ STATEFL._ ..___.__— 33469 TELEPHONE NUMBER 561-768-0424 SYSTEM USER JEFF EMAIL JSNYDER@TEQUESTA.ORG PRIMARY PHASE Make Checks Payable to: CLAIM FORMS PER SYSTEM SALES TAX 3 NCSPLUS Incorporated L IU Service Description: LEVEL 1 SERVICE FULL SYSTEMAMOUNT r PRICE nice S5000.00 RECEIVEDs TRANSFER AUTHORIZATION SECONDARY PLACEMENT•AMERICAN CREDIT MANAGEMENT DIVISION(ACM)SERVICE NCSPLUS Ir1COrpOraled(NCS)agrees that any account completing the Cosh Recovery System's Primary Phase(approximately 120 days of pursuit)uncollected,will automatically be treaaferred 10 the company's ACM Division for intensive wOskeut recovery service(Including Iiliga:lon,when warranted,at NCS-s expense) ACM v ie seance transferred accounts as second placements In accordance with the terms and conditions stated on page one and two of this agreement Client YE' AC711 Tfensler Client maintains the right to decline asslgnmore b ACM on all NO Primary Phase Must accounts,for thirty(30)days from the Notice of Tronsferdale,which -OR- Only Initial will be sent eher the Program's Primary Phase is completed. r 1 ACM STANDARD CONTINGENT COLLECTION FEE SCHEDULE 50% As specified on the reverse side of this agreement Client NO I Client Autic eri oass NCS Client YES NO Pia Iran.-eta*bete,you are trigua Ernstode, Must J To eepen Unpaid Acr:avnts Must cosses ns.,1 needed,inaccadanca r,eiis Initial 1 To The Three Neltonal Credit Duteous Initial 11` Frdnrai For Debt CoibUwn Prxticea Act. REMARKS ___ ACH AUTHORIZATION Charge to my credit card: 250 CLAIMS I Hereby A,bone tics to ACH my Checking Accau t - - try tr !eta irg into ces due NCS Q VISa U MIC U at my AMEX LEVEL 1 SERVICE Card No. __ ____ f7es9nature ---- Expires _ - .__.CSV .Siraire -- ._.. -. -c Jd i RDuNnq a --__--_ Copy 01 Credit Card MUST Please attach copy of check(File Copy) Accompany All Credit Card Orders(File Copy) Client's Association — _ Client Authorisation:NCS shall provide complete collection services on every account submitted,If an account Is transferred to NCS's ACM Division,the company shall negotiate,secure and process payments on submitted accounts and forward recovered hinds monthly net of contingent collection lees in accordance with ACM fee schedule detailed above. There Is no time limiton the Primary service.All payments and payment arrangements must be reported to NCS Collection forms,services and procedures may be changed from time to time due to sppllcabillty,availability andror to comply with state and redcoat law. ALL ORDERS ARE FINAL ONLY AFTER ACCEPTED AT NCS NEWYORK,NY, I have read page two ol this agreement and fully understand the terms end conditiensof the services performed and the guarantee.Tills written agreement constitutes the entire agreement betweontriepa a dcbn t be changed except In wilting signed by the parties. Signed by Client___ PnmaryRep_ _ - tan., Aerj G.si NirrnCN Ica Snyder,Faience Director . __... - - - -- ..._. ---------- --- Secondary Rep---_. Prior Name Wine --- -'— tie; Coat Nunes Page lof2 PUBLIC RECORDS. In accordance with Sec. 119.0701, Florida Statutes, CONTRACTOR must keep and maintain this Agreement and any other records associated therewith and that are associated with the performance of the work described in the Proposal or Bid. Upon request from the Village's custodian of public records, CONTRACTOR must provide the Village with copies of requested records, or allow such records to be inspected or copied, within a reasonable time in accordance with access and cost requirements of Chapter 119, Florida Statutes. A CONTRACTOR who fails to provide the public records to the Village, or fails to make them available for inspection or copying, within a reasonable time may be subject to attorney's fees and costs pursuant to Sec. 119.0701, Florida Statutes, and other penalties under Sec. 119.10, Florida Statutes. Further, CONTRACTOR shall ensure that any exempt or confidential records associated with this Agreement or associated with the performance of the work described in the Proposal or Bid are not disclosed except as authorized by law for the duration of the Agreement term, and following completion of the Agreement if the CONTRACTOR does not transfer the records to the Village. Finally, upon completion of the Agreement, CONTRACTOR shall transfer, at no cost to the Village, all public records in possession of the CONTRACTOR, or keep and maintain public records required by the Village. If the CONTRACTOR transfers all public records to the Village upon completion of the Agreement, the CONTRACTOR shall destroy any duplicate public records that are exempt or confidential and exempt from public records disclosure requirements. If the CONTRACTOR keeps and maintains public records upon completion of the Agreement, the CONTRACTOR shall meet all applicable requirements for retaining public records. Records that are stored electronically must be provided to the VILLAGE, upon request from the Village's custodian of public records, in a format that is compatible with the Village's information technology systems. IF CONTRACTOR HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER 119, FLORIDA STATUTES, TO CONTRACTOR'S DUTY TO PROVIDE PUBLIC RECORDS RELATING TO THIS AGREEMENT, PLEASE CONTACT THE VILLAGE CLERK, RECORDS CUSTODIAN FOR THE VILLAGE, AT (561) 768-0440, OR AT Imcwilliams@tequesta.org, OR AT 345 TEQUESTA DRIVE, TEQUESTA, FLORIDA 33469. Pursuant to Article XII of the Palm Beach County Charter, the Office of the Inspector General has jurisdiction to investigate municipal matters, review and audit municipal contracts and other transactions, and make reports and recommendations to municipal governing bodies based on such audits, reviews, or investigations. All parties doing business with the Village shall fully cooperate with the inspector general in the exercise of the inspector general's functions, authority, and power. The inspector general has the power to take sworn statements, require the production of records, and to audit, monitor, investigate and inspect the activities of the Village, as well as contractors and lobbyists of the Village in order to detect, deter, prevent, and eradicate fraud, waste, mismanagement, misconduct, and abuses. "The Village of Tequesta strives to be an inclusive environment. As such, it is the Village's policy to comply with the requirements of Title II of the American with Disabilities Act of 1990 ("ADA") by ensuring that the Contractor's [agreement/bid documents and specifications ] are accessible to individuals with disabilities. To comply with the ADA, the Contractor shall provide a written statement indicating that all [ agreement /bid documents and specifications], from Contractor, including files, images, graphics,text, audio, video, and multimedia, shall be provided in a format that ultimately conforms to the Level AA Success Criteria and Conformance Requirements of the Web Content Accessibility Guidelines 2.0 (Dec. 11, 2008) ("WCAG 2.0 Level AA"), published by the World Wide Web Consortium ("W3C"), Web Accessibility Initiative ("WAI"), available at www.w3.org/TR/WCAG/."