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Participation Agreement

Participation Agreement

Between

Harbor Homes Inc, NH-HMIS

and

[Agency Name]

This agreement is entered into on _______________, 2012 between Harbor Homes Inc,

hereafter known as “HHI,” and

(agency name), hereafter known as "Agency" (individually a “Party” and collectively the

“Parties”), regarding access and use of the New Hampshire Homeless Management Information

System (”NH-HMIS”), hereafter known as NH-HMIS, hereby enter into this Participation

Agreement (the “Participation Agreement”).

1. Preliminary Premises

In entering into this Agreement, the Parties acknowledge and agree as follows:

(a) The United States Department of Housing and Urban Development (“HUD”) in

connection with the Continuum of Care (CoC) and Emergency Solutions Grants (ESG), requires

that all grantees and subgrantees to participate in their local Homeless Management Information

System in order to provide data to HUD on the extent and nature of homelessness and the

effectiveness of HUD’s delivery system in preventing and ending homelessness.

(b) HHI is the agent for the operation of the HMIS program in New Hampshire, and

has agreed to administer the New Hampshire HMIS System (“NH-NMIS”) in accordance with

the most recently released HUD technical standards, pursuant to a contract between HHI and the

New Hampshire Department of Health and Human Services (“DHHS”).

(c) The NH-HMIS System is designed to comply in all respects with the Health

Insurance Portability and Accountability Act (HIPAA), and with all other federal, state, and local

laws and regulations relating to the disclosure of personal data and medical information.

(d) The goal of NH-HMIS is to improve the quality and analysis of information, to

enhance coordinate care for homeless persons in each of the New Hampshire CoC, to administer

a user-friendly and high-quality automatic records system in order to expedite client intake

procedures, to improve referral accuracy, and to generate data that can be used for program

improvement and service planning, and to meet the monthly reporting requirements of HUD, the

DHHS and other agencies.

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2. HHI Responsibilities

HHI shall have the following responsibilities under this Participation Agreement:

(a) HHI will use its best effort to provide the Agency twenty-four (24) hour access to

the NH-HMIS database system, except during routine system maintenance, scheduled system

upgrades and unexpected system failures.

(b) HHI will provide model Privacy Notices, Release forms and other templates for

agreements that may be adopted or adapted in local implementation of NH-HMIS functions.

(c) HHI will provide both initial training and periodic updates to that training for all

end users regarding the use of the NH-HMIS.

(d) HHI will provide basic user support and technical assistance (i.e., general trouble-

shooting and assistance with standard report generation). Access to this basic technical assistance

will normally be available from 8:30 AM. to 5:00 PM. on Monday through Friday (except for

holidays).

3. Privacy and Confidentiality

(1) The Agency shall maintain the confidentiality and privacy of the personal and

medical data of all of the individuals served by the Agency (the “Clients”). In addition to its

own policies addressing client confidentiality, the Agency shall comply with any applicable

Federal and State confidentiality regulations to protect Client records and privacy, including,

without limitation, the provisions of HIPAA Each Agency shall, before collecting any

information from any Client, obtain a copy of the then current New Hampshire Homeless

Management System Client Acknowledgement/Consent form in accordance with the provisions

of Section 4.E (the “Client Acknowledgement/Consent Form”). A copy of the current Client

Acknowledgement form is attached to this Participation Agreement and marked Exhibit B.

(2) The Agency shall provide a copy of the Client Acknowledgement/Consent form

to each consumer. The Agency will provide a verbal explanation of the NH-HMIS and arrange

for a qualified interpreter/translator or other reasonable accommodation in the event that an

individual is not literate in English or has difficulty understanding the Client

Acknowledgement/Consent Form (s).

HHI will provide Client Acknowledgement/Consent forms through the NH-HMIS

website, www.nh-hmis.org. These forms will also be available on line in Spanish and other

languages.

(3) Unless otherwise addressed in this data sharing agreement, the Agency will not

divulge any information received from the NH-HMIS to any organization or individual without

proper written consent by the Client, unless otherwise permitted by applicable regulations or

laws.

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(4) The Agency will ensure that all persons who are issued a User Identification and

Password to the NH-HMIS abide by this Participation Agreement, including all associated

confidentiality provisions. The Agency will be responsible for oversight of its own related

confidentiality requirements.

(5) The Agency agrees that it will ensure that all persons issued a User ID and

Password will complete a formal training on privacy and confidentiality and demonstrate

mastery of that information, prior to activation of their User License. The privacy and

confidentiality training must be consistent with HHI training or otherwise meet all required State

and Federal standards.

(6) The Agency acknowledges that maintaining the confidentiality, security and

privacy of information downloaded from the system by the Agency is strictly the responsibility

of the Agency.

(7) The Agency agrees to abide by all NH-HMIS Policies and Procedures, as the

same may be amended from time to time.

4. Inter-Agency Sharing of Information

(a) The Agency agrees in the NH-HMIS system that common set of person specific

data elements, as specified in NH-HMIS Policies and Procedures, will be shared among the

agencies represented by the signatories of this agreement.

(b) The information identified in 4(a) will be shared only for the purpose of providing

services that are specific to the Client or household identified in the NH-HMIS record.

(c) The Agency acknowledges that all forms provided by the HHI regarding Client

privacy and confidentiality are shared with the Agency as generally applicable with Agency-

specific rules. (See: http://www.nh-hmis.org)

(d) The Agency will review and provide recommendations for revision of any HMIS

documents to HHI. HHI will bring those recommendations to the NH-HMIS Advisory Council.

(e) The Agency will ensure that Clients are informed that their personal identifying

information will be entered into NH-HMIS and that all programs participating in the open system

follow all state and federal confidentiality laws and regulations. Furthermore, the Agency will

ensure that Clients are informed about the type of information that will be shared (as specified in

NH Policies and Procedures), and the programs that are participating in the open system. The

Agency will document the Client’s acknowledgement that this information has been provided,

through the HMIS Client Acknowledgement/Consent Form. (See: http://www.nh-hmis.org)

(f) Each Agency in this open system acknowledges that the Agency, itself, bears

primary responsibility for oversight for all sharing of data it has collected via the NH-HMIS.

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(g) The Agency acknowledges that Clients who choose not to provide certain

identifying information cannot be denied services for which they would otherwise be eligible.

5. Custody of Data

(a) The Agency acknowledges, and HHI agrees, that the Agency retains

responsibility for all information it enters into the NH-HMIS.

(b) The New Hampshire Dept. of Health and Human Services, Bureau of Homeless

and Housing Services, as the grantee for all Federal HMIS Supportive Housing Program funds,

owns the records that are developed as a result of the development of the database.

(c) Through its contract with the NHHS, HHI shall maintain overall operations,

maintenance, and services to ensure optimal quality of data contained in NH-HMIS.

6. Data Entry and Regular Use of HMIS

(a) The Agency will enter all minimum required data elements as specified by NH-

HMIS policy

(b) The Agency will enter data in a consistent manner as per NH-HMIS Policies and

Procedures

(c) The Agency will routinely review records it has entered in the NH-HMIS for

completeness and data accuracy. The review and data correction process will be made according

to NH-HMIS Policies and Procedures.

(d) The Agency will make every effort to ensure that information entered into NH-

HMIS is accurate.

(e) The Agency acknowledges that once that Client Acknowledgement/Consent Form

expires, any new information entered into the database will be closed to sharing. Information

entered before the date of the expired release will continue to be available to the sharing partners.

(f) The Agency acknowledges that the Client Acknowledgement/Consent Form

permits it to share person specific information specified in Section 4 with select agencies that

have signed this data sharing agreement.

(g) The Agency will ensure that no person with an Agency-assigned User ID and

Password will enter offensive language, profanity, or discriminatory comments based on race,

color, religion, national origin, ancestry, handicap, age, sex, and sexual orientation. These

prohibited actions are not limited to those listed above and include all other requirements found

in the HUD provisions found at the Federal Register Part III Department of HUD HMIS

provisions.

(h) The Agency will utilize the NH-HMIS for business purposes only.

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(i) The Agency agrees that the NH-HMIS Advisory Council, which has

representation from all NH CoCs may meet to discuss procedures, updates, policy and practice

guidelines, data analysis, and software/ hardware upgrades.

7. Database Integrity

(a) The Agency will not share assigned User ID’s and Passwords to access the NH-

HMIS with any other organization, governmental entity, business, or individual.

(b) The Agency will not intentionally cause corruption of the NH-HMIS in any

manner. Any unauthorized access or unauthorized modification to computer system information,

or interference with normal system operations, will result in immediate suspension of HMIS

licenses held by that Agency, and continued access to NH-HMIS by that Agency.

(c) All Agency participants must obtain and maintain corporate/business e-mail

accounts to be eligible to participate in distribution lists.

(d) HHI will investigate all potential violations of any security protocols. Any user

found to be in violation of security protocols will be sanctioned. Sanctions may include, but are

not limited to:

(1) A formal letter of reprimand to the State of NH, CoC Chair and Executive

Director;

(2) Suspension of system privileges; and

(3) Revocation of system privileges.

The Agency’s access may also be suspended or revoked if serious or repeated

violation(s) of HMIS Policies and Procedures occur by Agency users.

8. Warranties / Indemnification

(a) The Agency acknowledges the only responsibilities of HHI under this

Participation Agreement are set forth in Section 2. HHI makes no warranties or representations

of any kind as to the NH-HMIS system or the data collected under the system. Accordingly, the

Agency releases HHI from and against any and all liability arising out of or relating to the

operation of the NH-HMIS system, unless HHI materially breaches its obligations under Section

2 of this Participation Agreement.

(b) The Agency shall indemnify and hold HHI, its directors, officers, employees and

contractors, harmless from and against any damages, liabilities, claims, and expenses, including,

without limitation, attorneys’ fees and costs, arising out of or relating to this Participation

Agreement or the participation by the Agency in the NH-HMIS, including, without limitation,

any liability arising from (i) any acts, omissions, neglect, or fault of the Agency or its agents,

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employees, licensees, or clients; or arising from the Agency's failure to comply with laws,

statutes, ordinances, or regulations applicable to it or the conduct of its business; and (ii) any loss

or damage resulting in the loss of data due to delays, non-deliveries, mis-deliveries, or service

interruption caused by the Agency's negligence or errors or omissions, as well as natural

disasters, technological difficulties, and/or acts of God.

(c) Provisions of this section will survive any termination of the Participation

Agreement. All restrictions on the use and disclosure of Client information will also survive any

termination of the Participation Agreement.

9. Term and Termination

This Participation Agreement shall begin on the date hereof, and shall continue until

terminated by either Party, with or without cause, thirty (30) days prior written notice. Upon

such termination, all access of the Agency to the HMIS shall be terminated.

10. Miscellaneous

(a) The parties hereto agree that this Participation Agreement is the complete and

exclusive statement of the Agreement between parties and supersedes all prior proposals and

understandings, oral and written, relating to the subject matter of this Participation Agreement.

(b) The Agency shall not transfer or assign any rights, or delegate any of its duties or

regulations or obligations under this Participation Agreement without the prior written consent of

HHI.

(c) This Participation Agreement, and all rights, remedies, and obligations under this

Agreement, including matters of construction, validity, and performance, shall be governed by the

laws of the State of New Hampshire, without regard to its conflict of law rules which would refer to

and apply the substantive laws of another jurisdiction. The Parties hereby agree that the Federal and

State courts of the State of Hampshire shall have exclusive jurisdiction over the enforcement of this

Participation Agreement, and each Party specifically consents to, and agrees that the such the Party

is subject to, the jurisdiction of such courts with respect to any actions for enforcement of or breach

of this Participation Agreement.

(d) This Participation Agreement may be altered or amended in whole or in part at any

time, but only by a written instrument setting forth such changes and executed by each of the Parties

hereto or their respective successors or permitted assigns.

(e) In the event of a breach by Agency of the terms and conditions of this

Participation Agreement, HHI shall be entitled to cover all costs and expenses, including

reasonable attorney’s fees arising out of or relating to any legal action taken to enforce this

Participation Agreement.

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IN WITNESS WHEREOF, the parties have entered into this Participation Agreement:

AGENCY: HHI:

Harbor Homes, Inc.___________

By: By:

Donna Curley, Project Manager

Date: __________________________ Date:

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EXHIBIT A

REQUIRED DOCUMENTATION

_________________________________________ (Name of Agency) warrants and represents

that the following fully executed documents will be on file and available for review.

The Agency’s Board Approved Confidentiality Policy.

The Agency’s Grievance Policy, including a procedure for external review.

The Agency’s official Privacy Notice for HMIS clients.

Executed Agency Authorizations for Release of Information as needed.

Certificates of Completion for required training for all HMIS System Users.

A fully executed User Agreement for all HMIS System Users.

A current HMIS Policy and Procedure Manual.

By: ___________________________________

Title:

Signature:

Date:

Last Updated: XXXX 2012

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EXHIBIT B

CLIENT ACKNOWLEDGEMENT

NEW HAMPSHIRE HOMELESS MANAGEMENT SYSTEM (NH-HMIS)

NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW PERSONAL INFORMATION ABOUT YOU MAY

BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS

INFORMATION.

PLEASE REVIEW THIS CAREFULLY. This organization is required to use The New Hampshire Homeless Management Information System

(NH-HMIS) as the place to keep your personal information. Our staff must collect information about

you to provide our various services to you.

Information that tells us about your past, present or future health or mental health is called “Protected

Health Information.” There are Federal and State laws that protect the privacy of your protected

health information. Our agency and NH-HMIS comply with the requirements of these laws, and our

employees will only use or disclose Protected Health Information about you in order to provide you

with services and to comply with applicable laws. We are required by law to provide you with this

Notice of Privacy Practices to explain our responsibilities in safeguarding the privacy of your

Protected Health Information. Listed below is an explanation of how we may use or disclose

Protected Health Information about you. If we have a need to use or disclose your Protected Health

Information for any reasons other than those listed below, you will be asked to sign a written

authorization giving us your permission to share that information. If you sign an authorization for us

to share your Protected Health Information with an outside agency, we will follow your instructions.

We and NH-HMIS are required by law to follow the practices listed below.

• For Government Programs: Our organization may require that we disclose protected health

information about you to other government agencies to determine if you are eligible for government

benefits or programs such as Social Security benefits.

• For Public Health Activities: We may use or disclose Protected Health Information about you for

public health activities. For example, if you have been exposed to a communicable disease, we may

report it to the State and take other actions to prevent the spread of this disease.

• For Abuse and Neglect Reports and Investigations: We are required by law to report any cases

of suspected abuse or neglect of children or vulnerable adults.

• To Avoid Harm: We may disclose protected health information about you to law enforcement

under certain conditions. For example, if you harm a member of our staff or another client while on

our property, if you damage our property or if our professional staff believes that you are likely to

cause serious harm to others or yourself, we will contact law enforcement. NH-HMIS may also

disclose Protected Health Information in case of a threat to the public, such as a terrorist attack or

emergency disaster.

• For Court proceedings: If you are ever in court and your treatment becomes an issue, we may be

required by law to provide information about you to the court subsequent to a court order.

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Your Information Rights

You have the right to: • Ask us not to share your health information in the manner listed above by making a written request to our agency.

We are not required to agree to your request, but if we do we will follow the directions given to us.

• Obtain a copy of this Notice of Privacy Practices. This notice is available in alternative formats upon request.

• See, review and receive a copy of the information we maintain about you in certain records.

You must make this request in writing and you may be charged a fee to pay for the cost of copying your

record. There are certain situations when we may not give you the right to review your records. If this happens

we will explain why we made this decision.

• Make an amendment (a correction or addition) to your medical information if you feel the information we have is

inaccurate or incomplete. You must do this in writing.

• Receive an accounting (a detailed listing) of unauthorized disclosures we have made after July 1, 2012.

This listing will not include disclosures made for treatment, payment or health care operations purposes. You

must make this request in writing.

• Ask any questions about how we handle your Protected Health Information or to file a complaint or report a

problem.