Backup Documents 06/25/2019 Item #16D15 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 16 015
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1. Wendy Klopf Community and Human Irk 06.25.19
Services
2. County Attorney Office County Attorney Office V) las ( `C1
3. BCC Office Board of County \....,„"
Commissioners / \Z.1,4
4. Minutes and Records Clerk of Court's Office C
q71,10 it:Jots-.
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the
addressees above,may need to contact staff for additional or missing information.
Name of Primary Staff Wendy Klopf/CHS Phone Number 252-2901
Contact/ Department
Agenda Date Item was 06.25.19 V Agenda Item Number 16D15 /
Approved by the BCC V
Type of Document Business Associate Agreement Number of Original 3
Attached Documents Attached
PO number or account
number if document is
• to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signature? S ,,, ..,10 Ovc IOW to \p
2. Does the document need to be sent to another agency for additional signatures? If yes, NA
provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet.
3. Original document has been signed/initialed for legal sufficiency. (All documents to be WK
signed by the Chairman,with the exception of most letters,must be reviewed and signed
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's NA
Office and all other parties except the BCC Chairman and the Clerk to the Board
5. The Chairman's signature line date has been entered as the date of BCC approval of the WK
document or the final negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's WK
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip NA
should be provided to the County Attorney Office at the time th item is input into SIRE.
Some documents are time sensitive and require forwarding to allahassee within a certain
time frame or the BCC's actions are nullified. Be aware of our deadlines!
8. The document was approved by the BCC on 06.25.19 d all changes made during WK
the meeting have been incorporated in the attached document. The County
Attorney's Office has reviewed the changes,if applicable.
9. Initials of attorney verifying that the attached document is the version approved by the
BCC,all changes directed by the BCC have been made,and the document is ready for t e ti.a.0
Chairman's signature.
617
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I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12
1 6 D 15
MEMORANDUM
Date: June 27, 2019
To: Wendy Klopf, Grant Coordinator
Community & Human Services
From: Ann Jennejohn, Sr. Deputy Clerk
Minutes & Records Department
Re: Business Associate Agreement between the Area Agency on Aging
for Southwest Florida, Inc. (AAA SWFL) and Collier County
Attached you will find two original copies of the document referenced above,
(Item #16D15) approved by the Board of County Commissioners on June 25, 2019.
The Board's Minutes and Records Department has held the third original agreement
for the records of the Collier County Board of County Commissioners.
If you have any questions or if I can be of further assistance, please feel free to
contact me at 252-8406.
Thank you.
Attachments (2)
16015
Area Agency on Aging for Southwest Florida
Business Associate Agreement Provisions
The Area Agency on Aging for Southwest Florida (AAASWFL) is committed to protecting the confidentiality of
protected health information(PHI),whether it is maintained or distributed in hard copy,electronic,video, verbal or
oral form, and persons in the AAASWFL with access to such PHI shall be required to maintain confidentiality.
Access to PHI is limited to those who have a valid need for the information or otherwise have the right to know the
information. All personnel having access to CIRTS and/or ARTT must comply with all AAASWFL's policies and
procedures.
This Agreement shall serve to document the parties' wish to comply with the terms of the federal Health Insurance
Portability and Accountability Act of 1996 (HIPAA), as modified by the Health Information Technology for
Economic and Clinical Health Act(HITECH),the Florida Information Protection Act of 2014(FIPA), contained in
Section 501.171 Florida Statutes, and the regulations promulgated under these laws, as all may be amended.
Definitions
Catch-all definition:
The following terms used in this Agreement shall have the same meaning as those terms in the HIPAA Rules:
Breach, Data Aggregation, Designated Record Set, Disclosure, Health Care Operations, Individual, Minimum
Necessary, Notice of Privacy Practices and Protected Health Information, Required by Law, Secretary, Security
Incident, Subcontractor,Unsecured Protected Health Information, and Use.
Specific definitions:
(a) Business Associate. "Business Associate" shall generally have the same meaning as the term "business
associate"at 45 CFR 160.103, and in reference to the party to this agreement, shall mean COLLIER COUNTY
BOARD OF COUNTY COMMISSIONERS — HUMAN SERVICES, and shall include any and all of said
Business Associate's offices and locations.
(b) Covered Entity. "Covered Entity" shall generally have the same meaning as the term "covered entity" at 45
CFR 160.103, and in reference to the party to this agreement, shall mean Area Agency on Aging for Southwest
Florida(AAASWFL).
(c) HIPAA Rules. "HIPAA Rules" shall mean the Privacy, Security, Breach Notification, and Enforcement
Rules at 45 CFR Part 160 and Part 164.
Obligations and Activities of Business Associate
Business Associate agrees to:
(a)Not use or disclose protected health information other than as permitted or required by the Agreement or as
required by law;
(b) Use appropriate safeguards, and comply with Subpart C of 45 CFR Part 164 with respect to electronic
protected health information,to prevent use or disclosure of protected health information other than as provided
for by the Agreement;
JUN 10,19 RCVli
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� 6DPT
(c) Report to covered entity any use or disclosure of protected health information not provided for by the
Agreement of which it becomes aware,including breaches of unsecured protected health information as required
by HIPAA, as modified by HITECH and/or FIPA, regarding the unauthorized acquisition, access, use, or
disclosure of protected health information, or personal information(the attempted or successful unauthorized
access,use,disclosure,modification, or destruction of information or interference with system operations in the
information system). The report to the covered entity shall be made without unreasonable delay and in no case
later than ten(10)calendar days after the discovery of a security incident or security breach.
(d)In accordance with 45 CFR 164.502(e)(1)(ii)and 164.308(b)(2),if applicable,ensure that any subcontractors
that create, receive, maintain, or transmit protected health information on behalf of the business associate agree
to the same restrictions, conditions, and requirements that apply to the business associate with respect to such
information;
(e)Make available protected health information in a designated record set to the covered entity as necessary to
satisfy covered entity's obligations under 45 CFR 164.524;
(f) Make any amendment(s) to protected health information in a designated record set as directed or agreed to
by the covered entity pursuant to 45 CFR 164.526,or take other measures as necessary to satisfy covered entity's
obligations under 45 CFR 164.526;
(g)Maintain and make available the information required to provide an accounting of disclosures to the covered
entity as necessary to satisfy covered entity's obligations under 45 CFR 164.528;
(h)To the extent the business associate is to carry out one or more of covered entity's obligation(s)under Subpart
E of 45 CFR Part 164, comply with the requirements of Subpart E that apply to the covered entity in the
performance of such obligation(s); and
(i) Make its internal practices, books, and records available to the Secretary for purposes of determining
compliance with the HIPAA Rules.
(j) Adopt surety policies and training, as well as physical and technical surety safeguards appropriate for its
business to protect protected health information, or personal information, pursuant to the requirements of
HIPAA,as modified by HITECH and/or FIPA, as well as Florida security breach laws,to the extent the Florida
laws exceed the federal security breach notifications.
Permitted Uses and Disclosures by Business Associate
(a)Business associate may only use or disclose protected health information as necessary to perform the services
contracted by the Covered Entity. Business Associate is not to access any client information other than for those
clients which have been released to them from the Accessed Prioritized Consumer List by the Covered Entity.
(b) Business associate may use or disclose protected health information as required by law.
(c) Business associate agrees to make uses and disclosures and requests for protected health information
consistent with covered entity's minimum necessary policies and procedures.
(d) Business associate may not use or disclose protected health information in a manner that would violate
Subpart E of 45 CFR Part 164 if done by covered entity.
Page 2 of 4
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16015.
(e)Business associate may disclose protected health information for the proper management and administration
of business associate or to carry out the legal responsibilities of the business associate, provided the disclosures
are required by law, or business associate obtains reasonable assurances from the person to whom the
information is disclosed that the information will remain confidential and used or further disclosed only as
required by law or for the purposes for which it was disclosed to the person, and the person notifies business
associate of any instances of which it is aware in which the confidentiality of the information has been breached.
Provisions for Covered Entity to Inform Business Associate of Privacy Practices and Restrictions
(a) Covered entity shall notify business associate of any restriction on the use or disclosure of protected health
information that covered entity has agreed to or is required to abide by under 45 CFR 164.522,to the extent that
such restriction may affect business associate's use or disclosure of protected health information.
Permissible Requests by 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 Subpart E of 45 CFR Part 164 if done by covered entity.
Term and Termination
(a) Term. The Term of this Agreement shall be effective as of July 1, 2019 and shall terminate on the date
covered entity terminates for cause as authorized in paragraph(b) of this Section.
(b) Termination for Cause. Business associate authorizes termination of this Agreement by covered entity, if
covered entity determines business associate has violated a material term of the Agreement.
(c)Obligations of Business Associate upon Termination.
Upon termination of this Agreement for any reason, business associate shall return to covered entity or, if agreed
to by covered entity, destroy all protected health information received from covered entity, or created,
maintained, or received by business associate on behalf of covered entity, that the business associate still
maintains in any form. Business associate shall retain no copies of the protected health information. Business
associate shall take all reasonable measures to dispose, or arrange for the disposal, of customer records
containing personal information within its custody or control when the records are no longer to be retained.
Such disposal shall involve shredding, erasing, or otherwise modifying the personal information in the records
to make it unreadable or undecipherable through any means.
(d) Survival. The obligations of business associate under this Section shall survive the termination of this
Agreement.
Miscellaneous
(a) Regulatory References. A reference in this Agreement to a section in the HIPAA, HITECH or FIPA rules
means the section as in effect or as amended.
(b) Interpretation. Any ambiguity in this Agreement shall be interpreted to permit compliance with the HIPAA,
HITECH and FIPA rules.
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16D15
IN WITNESS WHEREOF, the Covered Entity and Business Associate have executed the Agreement as of the
day and year written above.
BUSINESS ASSOCIATE COVERED ENTITY
COLLIER COUNTY BOARD OF AREA AGENCY ON AGING FOR
COUNTY COMMISSIONERS SOUTHWEST FLORIDA,INC.
3299 Tamiami Trail E 15201 North Cleveland Ave, Suite 1100
Naples FL34112 North Fort Myers, FL 33903
ATTEST: BOARD OF COUNTY COMMISSIONERS OF
COLLIER COUNTY, FLORIDA
CRYSTAL K.KINZEL, CLERK
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By: _ __
4 { 4 WILLI•/ L. MCDANIEL, JR, CHAIRMAN
�� -,. .. CLERK
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Date: am>e_. 25, Zc IC9
Dated: (f ai' `9 By: .7k11",111•40(11- AlfvVt.
(SEAL) MARIANNE LORINI, PRESIDENT&CEO
Date: 6/V/9
Approved as to form and legality:
4a-1)13S
Jennifer A. BelpedioC CACP �
Assistant County Attorney
Date: (o1 a S ',9 item# i(,,®b 1 V
Agenda/ J:�
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Date (1
Date /A. u0.• 9
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