CCR2003145.
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COMMON COUNCIL. CITY OF MUSKEGO
RESOLUTION #145-2003
APPROVAL OF BUSINESS ASSOCIATE AGREEMENT
BETWEEN THE CITY OF MUSKEGO AND
TESS CORNERS VOLUNTEER FIRE DEPARTMENT
FOR AMBULANCE BILLING SERVICES IN COMPLIANCE WITH HIPAA
WHEREAS, The attached Business Associate Agreement between the City of Muskego
and Tess Corners Volunteer Fire Department is required to comply with the Health
Insurance Portability and Accountability Act of 1996 (HIPAA) to assure privacy of
confidential health care information; and
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WHEREAS, The Finance Committee has reviewed the attached Agreement and has
recommended approval.
NOW, THEREFORE, BE IT RESOLVED That the Common Council of the City of
Muskego, upon the recommendation of the Finance Committee, does hereby approve
the attached Business Associate Agreement between the City of Muskego and Tess
Corners Volunteer Fire Department for ambulance billing services in compliance with
HIPAA.
BE IT FURTHER RESOLVED That the Mayor and Clerk-Treasurer are authorized to
sign the Agreement in the name of the City with any necessary technical corrections to
be made if necessary.
DATED THIS 24th DAY OF June .2003.
SPONSORED BY
FINANCE COMMITTEE
Ald. Rick Petfalski
Ald. Nancy Salentine
Ald. Eric Schroeder
This is to certify that this is a true and accurate copy of Resolution #145-2003 which
was adopted by the Common Council of the City of Muskego.
6/2003jmb ~KfY7~ C k-Treasurer
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CITY OF MUSKEGO AND TESS CORNERS VOLUNTEER FIRE DEPARTMENT
BUSINESS ASSOCIATE AGREEMENT
FOR AMBULANCE BilLING SERVICES IN COMPLIANCE WITH HIPAA
Business Associate Obligations
1. CITY OF MUSKEGO, also referred to as Business Associate, shall carry out its
obligations under this Business Associate Agreement (Agreement) in compliance
with the privacy regulations (hereinafter Privacy Rule) pursuant to Public law
104-191 of August 21, 1996, known as the Health Insurance Portability and
Accountability Act of 1996, Subtitle F - Administrative Simplification, Sections
261, et seq., as amended ("H I PAA")
, to protect the privacy of any personally
identifiable protected health information ("PHI") that is collected, processed or
learned as a result of the Billing Services provided hereunder. Capitalized terms
not otherwise are defined herein are to be given the same meaning as used in
the Privacy Rule. Tess Corners Volunteer Fire Department, also referred to as
TCVFD and/or Covered Entity, In conformity therewith, CITY OF MUSKEGO
agrees that it will:
A. Not use or further disclose PHI except as permitted under this Agreement, the
Privacy Rule, or as otherwise required by law;
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B. Use appropropriate safeguards to prevent use or disclosure of PHI except
as permitted by this Agreement, the Privacy Rule, or as otherwise required
bylaw;
C. To mitigate, to the extent practicable, any harmful effect that is known
to CITY OF MUSKEGO of a use or disclosure of PHI by the CITY OF
MUSKEGO in violation of this Agreement;
D. Report to TCVFD any use or disclosure of PHI not provided for by this
Agreement of which CITY OF MUSKEGO becomes aware;
E. Ensure that any agents or sybcontractors to whom CITY OF MUSKEGO
provides PHI, or who have access to PHI, agree to the same restrictions
and conditions that apply to CITY OF MUSKEGO with respect to such PHI;
F. Make PHI available to TCVFD and to the Individual who has a right of
access as required under HIPAA within 30 days of the request by
TCVFD on the Individual;
G. Incorporate any amendments to PHI when notified to do so by TCVFD;
H. Provide an accounting of all uses or disclosures of PHI made by CITY OF
MUSKEGO as required under the Privacy Rule within 60 days;
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City of Muskego & TCVFD
Business Association Agreement - Ambulance Services
Page 2
I. Make its internal practices, books and records relating to the use and
disclosure of PHI available to the Secretary of the Department of Health
and Human Services for purposes of determining CITY OF MUSKEGO'S
and TCVFD'S compliance with the Privacy Rule; and
J. At the termination of this Agreement, return or destroy all PHI received from,
or created or received by CITY OF MUSKEGO on behalf of TCVFD, and if
return is infeasible, the protections of this Agreement will extend to such PH I.
2. The specific uses and disclosures of PHI that may be made by CITY OF
MUSKEGO on behalf of TCVFD include:
A. The preparation of invoices to patients, carriers, insurers and others
responsible for payment or reimbursement of the services provided by
TCVFD to its patients;
B. Preparation of reminder notices and documents pertaining to collections of
overdue accounts;
C. The submission of supporting documentation to carriers, insurers and other
payers to substantiate the health care services provided by TCVFD to its
patients or to appeal denials of payment for same.
D. Uses required for the proper management of the CITY OF MUSKEGO as a
Business Associate.
E. Other uses or disclosures of PHI as permitted by Privacy Rule or as
otherwise required by law.
TCVFD's Obligations
3. TCVFD shall notify Business Associate of:
. A. Any limitation in its Notice of privacy practices in accordance with the Privacy
Rule, to the extent that such limitation may affect Business Associate's use or
disclosure of PHI;
B. Any changes in, or revocation of permission by Individual to use or disclose
PHI, to the extent that such limitation may affect Business Associate's use or
disclosure of PHI;
C. Anyrestriction to the use or disclosure PHI that TCVFD has agreed to in
accordance with the Privacy Rule, to the extent that such limitation may affect
Business Associate's use or disclosure of PHI.
4. TCVFD shall not request CITY OF MUSKEGO to use or disclose PHI in any
manner that would not be permissible under the Privacy Rule if done by TCVFD.
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City of Muskego & TCVFD
Business Association Agreement - Ambulance Services
Page 3
5. Termination. Notwithstanding any other provisions of this Agreement, this
Agreement may be terminated by TCVFD, in its sole discretion if TCVFD
determines that CITY OF MUSKEGO has violated a material term or provision of
this Agreement pertaining to TCVFD's obligations under the Privacy Rule, or if
CITY OF MUSKEGO engages in conduct which, if committed by TCVFD, would
result in a violation of the Privacy Rule by TCVFD.
6. Severability. The provisions of this Agreement are severable, and if any part of
the Agreement is found by a court of competent jurisdiction to be unenforceable,
the other parts shall remain fully valid and enforceable. This Agreement shall
remain fully valid and enforceable. This Agreement shall survive the termination
of any arrangements contained in it.
CITY OF MUSKEGO TCVFD
Mayor President
Clerk-Treasurer Rescue Captain
S:CityHall:CommonCouncil:Resolutions:CCR2003145HIP AA.doc