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2003-050
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2003-050
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Last modified
9/27/2016 2:22:17 PM
Creation date
9/30/2015 6:22:38 PM
Metadata
Fields
Template:
Official Documents
Official Document Type
Agreement
Approved Date
03/04/2003
Control Number
2003-050
Agenda Item Number
7.U.
Entity Name
Agency for Health Care Administration
Subject
Medicaid Program data sharing agreement
Archived Roll/Disk#
3160
Supplemental fields
SmeadsoftID
3172
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a -ata <br /> DATA SHARING AGREEMENT <br /> This agreement is entered by and between the State of Florida, Agency for Health Care <br /> Administration , hereinafter referred to as the Agency , and Indian River County, hereinafter <br /> referred to as the County . <br /> Whereas , the Agency shall make available to the County certain data that is confidential <br /> and must be afforded special treatment and protection ; and, <br /> Whereas , the County shall receive and have access to data from the Agency that can be <br /> used or disclosed only in accordance with this agreement and state and federal law ; <br /> Now , therefore , the Agency and the County agree as follows : <br /> 1 . Purpose of Agreement. The County represents , and in furnishing the data specified in <br /> this agreement the Agency relies upon such representation , that the data specified in this <br /> agreement will be used solely for purposes of Medicaid services pursuant to Section <br /> 409 . 915 , Florida Statutes (2002) . <br /> 2 . Justification for Access . This agreement is authorized by law under section 1902 (a) (7 ) <br /> of the Social Security Act . Section 1902(a) (7) of the Social Security Act mandates that a <br /> State Medicaid Plan provide safeguards that restrict the use or disclosure of information <br /> concerning applicants and recipients to purposes directly connected with the <br /> administration of the Plan . This agreement implements this statute by allowing the <br /> Agency to disclose the data necessary for the administration of the Medicaid program . <br /> 3 . Description of Data . To enable the County to contribute its share of matching funds <br /> required for the Medicaid program, the Agency may disclose invoices for certain items of <br /> care and service for which the Agency has determined the County has financial liability. <br /> 4 . Point of Contact. The Agency designates the following individual as the Agency ' s point <br /> of contact for this agreement : <br /> David Herman , AHCA Privacy Officer <br /> Name of point of contact <br /> 2727 Mahan Drive , Mail Stop 1 , Bldjz 3 , Mail Stop 1 <br /> Street address <br /> Tallahassee , Florida 32308 <br /> City/ State/ Zip code <br /> 850-488 -2734 <br /> Phone number <br /> All correspondence regarding this agreement, including, but not limited to , notification of <br /> change of custodianship , uses or disclosures of the data not provided for by this <br />
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