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Home My WebLink About5.1088 Original ContractBUSINESS ASSOCIATE CONTRACT Between The City of Port Angeles and Olympic Ambulance Service, Inc. THIS AGREEMENT is made this pci day (Pelt. 2010, by and between the City of Port Angeles, a municipal corporation of the State of Washington, hereinafter referred to as "City and Olympic Ambulance Service, Inc., a Washington corporation, hereinafter referred to as "Olympic Ambulance." The City and Olympic Ambulance are sometimes referred to herein in the singular as "Party" and in the plural as "Parties." WHEREAS, the City and Olympic Ambulance have an existing business relationship that may involve Protected Health Information as defined by federal law, which is subject to federal regulations issued pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA). WHEREAS, the City and Olympic Ambulance enter into this Business Associate Contract in order (1) to comply with HIPAA regulations regarding Protected Health Information, and (2) to facilitate joint review of medical incident reports for quality assurance purposes. NOW, THEREFORE, in consideration of the foregoing, the Parties mutually covenant and agree as follows: I. Definitions. Terms used, but not otherwise defined, in this Agreement shall have the same meaning as those terms in the Privacy Rule. a. Business Associate. "Business Associate" shall mean Olympic Ambulance. b. Covered Entity. "Covered Entity" shall mean City of Port Angeles. c. Individual. "Individual" shall have the same meaning as the term "individual" in 45 CFR 160.103 and shall include a person who qualifies as a personal representative in accordance with 45 CFR 164.502(g). d. Privacy Rule. "Privacy Rule" shall mean the Standards for Privacy of Individually Identifiable Health Information at 45 CFR Part 160 and Part 164, Subparts A and E. e. Protected Health Information. "Protected Health Information" shall have the same meaning as the term "protected health information" in 45 CFR 160.103, limited to the information created or received by Business Associate from or on behalf of Covered Entity. f. Required By Law. "Required By Law" shall have the same meaning as the term "required by law" in 45 CFR 164.103. hoST g. Secretary. "Secretary" shall mean the Secretary of the Department of Health and Human Services or his designee. II. Oblieations and Activities of Business Associate. a. Business Associate agrees to not use or disclose Protected Health Information other than as permitted or required by the Agreement or as Required By Law. b. Business Associate agrees to use appropriate safeguards to prevent use or disclosure of the Protected Health Information other than as provided for by this Agreement. c. Business Associate agrees to mitigate, to the extent practicable, any harmful effect that is known to Business Associate of a use or disclosure of Protected Health Information by Business Associate in violation of the requirements of this Agreement. d. Business Associate agrees to report to Covered Entity any use or disclosure of the Protected Health Information not provided for by this Agreement of which it becomes aware. e. Business Associate agrees to ensure that any agent, including a subcontractor, to whom it provides Protected Health Information received from, or created or received by Business Associate on behalf of Covered Entity agrees to the same restrictions and conditions that apply through this Agreement to Business Associate with respect to such information. f. Business Associate agrees to provide access within 10 days, at the request of Covered Entity, to Protected Health Information in a Designated Record Set, to Covered Entity or, as directed by Covered Entity, to an Individual in order to meet the requirements under 45 CFR 164.524. Business Associate agrees to make internal practices, books, and records, including policies and procedures and Protected Health Information, relating to the use and disclosure of Protected Health Information received from, or created or received by Business Associate on behalf of, Covered Entity available to the Covered Entity within 10 days for purposes of determining Covered Entity's compliance with the Privacy Rule. h. Business Associate agrees to document such disclosures of Protected Health Information and information related to such disclosures as would be required for Covered Entity to respond to a request by an Individual for an accounting of disclosures of Protected Health Information in accordance with 45 CFR 164.528. Business Associate agrees to provide to Covered Entity or an Individual, within 10 days, information collected in accordance with Section II of this Agreement, to permit Covered Entity to respond to a request by an Individual for an accounting of disclosures of Protected Health Information in accordance with 45 CFR 164.528. g. 2 III. Permitted Uses and Disclosures bv Business Associate. a. Purposes. Except as otherwise limited in this Agreement, Business Associate may use or disclose Protected Health Information on behalf of, or to provide services to, Covered Entity for the following purposes, if such use or disclosure of Protected Health Information would not violate the Privacy Rule if done by Covered Entity or the minimum necessary policies and procedures of the Covered Entity: 1. To facilitate the coordination and administration, as between the Covered Entity and the Business Associate, of health care services and patient transport. 2. Audits of Basic Life Support (BLS) ambulance transports within the City of Port Angeles. IV. Permissible Reuuests bv Covered Entity. Covered Entity shall not request Business Associate to use or disclose Protected Health Information in any manner that would not be permissible under the Privacy Rule if done by Covered Entity. V. Term and Termination. a. The Term of this Agreement shall be effective as of /and shall terminate when all of the Protected Health Information provided by Covered Entity to Business Associate, or created or received by Business Associate on behalf of Covered Entity is destroyed or returned to Covered Entity, or, if it is infeasible to return or destroy Protected Health Information, protections are extended to such information in accordance with the termination provisions in this Section. b. Termination for Cause. Upon Covered Entity's knowledge of a material breach by Business Associate, Covered Entity shall either: 1. Provide an opportunity for Business Associate to cure the breach or end the violation and terminate this Agreement if Business Associate does not cure the breach or end the violation within the time specified by Covered Entity; 2. Immediately terminate this Agreement if Business Associate has breached a material term of this Agreement and cure is not possible; or 3. If neither termination nor cure are feasible, Covered Entity shall report the violation to the Secretary. VI. Effect of Termination. a. Except as provided in paragraph (b) of this section, upon termination of this Agreement, for any reason, Business Associate shall return or destroy all Protected Health Information received from Covered Entity, or created or received by Business Associate on behalf of Covered Entity. This provision shall apply to Protected Health Information that is in the possession of subcontractors 3 Attest: or agents of Business Associate. Business Associate shall retain no copies of the Protected Health Information. b. In the event that Business Associate determines that returning or destroying the Protected Health Information is infeasible, Business Associate shall provide to Covered Entity notification of the conditions that make return or destruction infeasible. Upon 10 days notice that return or destruction of Protected Health Information is infeasible, Business Associate shall extend the protections of this Agreement to such Protected Health Information and limit further uses and disclosures of such Protected Health Information to those purposes that make the return or destruction infeasible, for so long as Business Associate maintains such Protected Health Information. VII. Miscellaneous. a. Regulatory References. A reference in this Agreement to a section in the Privacy Rule means the section as in effect or as amended. b. Amendment. The Parties agree to take such action as is necessary to amend this Agreement from time to time as is necessary for Covered Entity to comply with the requirements of the Privacy Rule and the Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104 -191. c. Survival. The respective rights and obligations of Business Associate under Section II. of this Agreement shall survive the termination of this Agreement. d. Inter retation. Any ambiguity in this Agreement shall be resolved to permit Covered Entity to comply with the Privacy Rule. CITY OF PORT ANGELES By: Kent M City Manager ssa Hurd, City Clerk Approv d as to form: William E. Bloor, City Attorney OLYMPIC AMBULANCE SERVIC,, INC. 4 G:1Lagalla AGREEMENTS&CONTRACTS \2010 Agrmts &Contracts\Medic LBusiness Associate Contract Olympic Ambulance.081610 doc DECLARATIONS FOR A BUSINESS AUTO AMENDED 12/09/11 ITEM ONE Named Insured and Address OLYMPIC AMBULANCE INC AND OR BREMERTON AMBULANCE IN 601 HENDRICKSON ROAD SEQUIM WA 98382 Producer Code: .100 LIABILITY COVERAGES PERSONAL INJURY PROTECTION (or equivalent No —fault coverage) ADDED PERSONAL INJURY PROTECTION (or equivalent added No —fault coverage) PROPERTY PROTECTION INSURANCE (Michigan only) AUTO MEDICAL PAYMENTS UNINSURED MOTORISTS UNDERINSURED MOTORISTS (When not included in Uninsured Motorists Coverage) PHYSICAL DAMAGE COMPREHENSIVE COVERAGE PHYSICAL DAMAGE SPECIFIED CAUSES OF LOSS COVERAGE PHYSICAL DAMAGE COLLISION COVERAGE PHYSICAL DAMAGE TOWING AND LABOR (Not available in California) DELETE VEHICLE #41 2005 FORD #7037 EFFECTIVE 12/09/11 PER BINDING. CA DS 03 03 06 Batch Rep Cur Date Run Seq F28358 E G 11353 98 7 8 9 7 Policy No. Broker .1D$r Page 1 CPW 6873977 1 Producer Name and Address EMSA I INC 5063 ROUTE 17M PO BOX 380 NEW HAMPTON Report Basis. ANNUAL Policy Period: From 07/15/11 to 07/15/12 at 12:01 A M Standard Time at your mailing address shown above. Insurer Company and Code: NATIONAL CONTINENTAL INSURANCE COMPANY Named Insured's Business: 4 AMBULANCE SERVICE *NRP* Form of Business CORPORATION *RETURN PREMIUM $2,184- *This policy may be subject to final audit IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY NY 10958 ITEM TWO SCHEDULE OF COVERAGES AND COVERED AUTOS This policy provides only those coverages where a charge is shown in the premium column on the covered autos schedule Each of these coverages will apply only to those "autos" shown as covered "autos" "Autos" are shown as covered "autos" for a particular coverage by the entry of one or more symbols from the COVERED AUTO Section of the Business Auto Coverage Form next to the name of the coverage COVERED AUTOS LIMIT (Entry of one or more of the symbols from the COVERED AUTOS THE MOST WE WILL PAY FOR ANY ONE Section of the Business Auto ACCIDENT OR LOSS Coverage Form shows which autos are covered autos) 1,000,000 CSL Separately stated in each PIP endorsement Separately stated in each added PIP endorsement Separately stated in the P.P.I endorsement 100,000 PER PERSON 300,000 PER ACCIDENT 50,000 PER ACCIDENT ACTUAL CASH VALUE OR COST OF REPAIR, WHICHEVER IS LESS MINUS Ded FOR EACH COVEREC AUTO BUT NO DEDUCTIBLE APPLIES TO LOSS CAUSED BY FIRE OR LIGHTNING See ITEM FOUR for hired or borrowed "autos ACTUAL CASH VALUE OR COST OF REPAIR, WHICHEVER IS LESS MINUS Ded. FOR EACH COVERED AUTO FOR LOSS CAUSED BY MISCHIEF OR VANDALISM. See ITEM FOUR for hired or borrowed "autos." ACTUAL CASH VALUE OR COST OF REPAIR, WHICHEVER IS LESS MINUS Ded. FOR EACH COVEREC AUTO. See ITEM FOUR for hired or borrowed "autos" for each disablement of a private passenger auto. End Last Run Eff Date Pages Yr PADDLIN DEC 027 11313 12/09/11 795 11 PMD DECLARATIONS FOR A BUSINESS AUTO Page 2 FORMS AND ENDORSEMENTS CONTAINED IN THIS POLICY AT ITS INCEPTION: SEE SCHEDULE ATTACHED FILINGS MISCELLANEOUS FILING 30 -DAY NOTICE OF CANCELLATION OTHER CHARGES INCLUDED WITH POLICY TOTAL PREMIUM COUNTERSIGNED 12/09/11 BY CA DS 03 03 06 Batch Rep Cur Date Run Sea, End Last Run Eff Date Pages Yr PADDLIN DEC F28358 E G 11353 98 027 11313 12/09/11 796 11 PMD