Pccc Agency Agreement Final

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Pccc Agency Agreement    Final Powered By Docstoc
                 For the Polk County Continuum of Care (PCCC)
                Homeless Management Information System (HMIS)

The Polk County Continuum of Care is a collaboration of community participants involved in
serving the needs of the homeless. The Polk County Continuum of Care also is the focal point for
various funding efforts.

The PCCC Homeless Management Information System is a client information system that
provides the ability to record data required for HUD reporting standards. The HMIS will also
provide the ability to provide aggregate data that is not specific to the client, which can use to
determine the utilization of services of Participating Agencies, and identification of gaps in the
local service continuum and develop outcome measurements. .

The HMIS will also provide the option of recording standardized assessment of consumer needs,
creation individualized service plans and the recording of housing and services.

The Homeless Coalition of Polk County, Inc. (HCPC) is the Lead Agency that serves the
collaborative effort of Polk County Continuum members. As such, it is the primary licensee of
the Homeless Management Information System to facilitate central funding and administration.

In this Agreement, “Participating Agency” is an Agency participating in the Homeless
Management Information System, “Collaborating Agency” is a participant in sharing of data
through HMIS, "Client" is a consumer of services, and “Agency” is the Agency named in this
agreement. HCPC shall be the “system administrator” for the Polk County Continuum of Care
(PCCC) Homeless Management Information System (HMIS)

HCPC provides technical assistance to the Participating Agency(s). HCPC is not a Participating
Agency and has no ownership of the client records. HCPC is an independent “Business
Associate” as defined by HIPAA regulations.

I. Confidentiality

A. The Agency acknowledges it is responsible to uphold relevant federal and state confidentiality
regulations and laws that protect Client records. The Agency shall only release client records
with written consent by the client, unless otherwise provided for in the regulations.

1. The Agency shall abide specifically by federal confidentiality regulations as contained in the
Code of Federal Regulations, 42 CFR Part 2 regarding disclosure of alcohol and/or drug abuse
records. In general terms, the federal rules prohibit the disclosure of alcohol and/or drug abuse
records unless disclosure is expressly permitted by written consent of the person to whom it
pertains or as otherwise permitted by 42 CFR Part 2. A general authorization for the release of
medical or other information is not sufficient for this purpose. The Agency understands the
federal rules restrict any use of the information to criminally investigate or prosecute any alcohol
or drug abuse patients.

2. The Agency shall provide a verbal explanation of the database and the terms of consent and
shall arrange for a qualified interpreter or translator in the event that an individual is not literate in
English or has difficulty understanding the consent form.

3. The Agency shall not solicit or input information from Clients into the database unless it is
essential to provide services, or to conduct evaluation or research.

4. The Agency agrees not to release any confidential information received from the database to
any organization or individual without proper Client consent.

5. The Agency shall ensure that all staff, volunteers and other persons issued a User ID and
password for receives basic confidentiality training and that a single user is identified for each
user identification and password issued.

6. The Agency understands that the Client data will be encrypted at the server level using
encryption technology.

7. The Agency understands the file server, which will contain all Client information, including
encrypted identifying Client information, will be located at a location chosen by Bowman Internet
System, Inc. Bowman main administrative offices are at 400 Travis Street, Suite 1900,
Shreveport, Louisiana 71101.

8. The Agency shall maintain appropriate documentation of Client consent to participate in the

9. The Agency shall not be denied access to Client data entered by the Agency. Participating
Agencies are bound by all restrictions placed upon the data by the client of any Participating
Agency. The Agency shall diligently record in the system all restrictions requested. The Agency
shall not knowingly enter false or misleading data under any circumstances.

10. If this Agreement is terminated for any reason, the PCCC and remaining Collaborating
Agencies shall maintain their right to the use of all Client data previously entered by the
terminating Collaborating Agency; this use is subject to any restrictions requested by the Client.
All data by participating agencies without collaboration agreements will be deleted upon

11. The Agency will utilize an appropriate Client Consent/Information Release form, as
developed in conjunction and coordination with Collaborating Agencies, for all clients providing
information for the database. The Client Consent/Information Release form, once signed by the
Client, authorizes Client data to be entered into the database and authorizes information sharing
with Collaborating Agencies.

12. If a Client withdraws consent for release of information, the Collaborating Agency remains
responsible to ensure that Client’s information is the unavailable to all other Collaborating

13. The Agency shall keep signed copies of the Client Consent Form/Information Release forms
for a period of three years.

14. The Agency may utilize the PCCC HMIS to collaborate with another Collaborating Agency
by sharing client information. The Agency is responsible to determine if collaboration is

appropriate and is responsible to implement interagency procedures to comply with all privacy
regulations. Each Collaborating Agency is responsible to independently monitor the sharing of
client data. HCPC will provide technical assistance in the procedures to enable sharing of client
data through HMIS but is not a participant in the collaboration. HCPC is not responsible for the
use of client data by the Collaborating Agency(s).

15. This Participating Agency Agreement does not require or imply that services must be
contingent upon a Client's participation in the database. Services should be provided to Clients
regardless of participation provided the Clients would otherwise be eligible for the services.

II. Use and Data Entry

A. The Agency shall establish, comply with and enforce a User Policy, Responsibility Statement
& Code of Ethics (Attachment A).

1. The Agency shall only enter individuals in the database that exist as Clients under the Agency's
jurisdiction. The Agency shall not misrepresent its Client base in the database by entering known,
inaccurate information.

2. The Agency shall use Client information in the database, as provided to the Agency or
Participating Agencies, to assist the Agency in providing adequate and appropriate services to the

B. The Agency shall consistently enter information into the database and will strive for real-time,
or close to real-time Data Entry.

C. The Agency will not alter information in the database that is entered by another Agency with
known, inaccurate information. (I.e. Agency will not purposefully enter inaccurate information to
over-ride information entered by another Agency).

D. The Agency shall not include profanity or offensive language in the database.

E. The Agency shall utilize the database for business purposes only.

F. The transmission of material in violation of any federal or state regulations is prohibited. This
includes, but is not limited to, copyright material, material legally judged to be threatening or
obscene, and material considered protected by trade secret.

G. The Agency shall not use the database with intent to defraud federal, state or local
governments, individuals or entities, or to conduct any illegal activity.

III. System Administration

A. HCPC will provide initial training and periodic updates to that training to select Agency Staff
on the use of the software.

B. HCPC will be available for technical assistance within reason (i.e. troubleshooting and report

C. HCPC will provide license administration, user identification and password initiation for the
Participating Agencies involved in the PCCC.

D. User licenses and support services will be paid through Grant funding where possible. Each
Participating Agency will be provided with an equal pro-rata allocation toward User Licenses and
support fess as may be permitted by Grant funds available. Additional licenses, beyond the pro-
rata share provided by Grant funding, shall be at the expense of the Participating Agency(s).

E. HCPC will monitor operation of HMIS and notify Participating Agency(s), and PCCC when
appropriate, upon discovery of any erroneous data or erroneous application of the system. HCPC
is not responsible for management of the data for the Participating Agency(s) and is not
responsible to discover any erroneous data or erroneous application of the system.

IV. Reports

A. The Agency shall retain access to identifying and statistical data on the Clients it serves.

B. The Agency’s access to data on Clients it does not serve shall be limited to non-identifying
data and statistical data through the PCCC.

C. HCPC will prepare only unidentified, aggregate data to enable the PCCC and the Participating
Agency(s) to develop homeless policy and planning decisions, in preparing federal, state or local
applications for homelessness funding, to demonstrate the need for and effectiveness of programs
and to obtain a system-wide view of program utilization in the state.

V. Use of the HMIS

A. The Agency shall not give or share assigned passwords and access codes of the database with
any other Agency, business, or individual.

B. The Agency shall not cause in any manner, or way, corruption of the database in any manner.

VI. Terms and Conditions

A. Neither the PCCC nor the Agency shall transfer or assign any rights or obligations without the
written consent of the other party.

B. This Agreement may be terminated with 90 days written notice.

C. See Addendum I where applicable.

The signature of the Executive Director of the Participating Agency indicates agreement with the
terms set forth that govern an account established by the Agency.

Signature of Executive Director ______________________________Date _______________
AGENCY _________________________________________________________________________________________________

STREET ADDRESS _________________________________________________________________________________________

CITY________________________________________________________________, Florida ZIP CODE ___________________

                                   Addendum I
                               HMIS Equipment Loans
The Homeless Coalition of Polk County, Inc. has acquired computer equipment as part of the
HUD funded initiative to support the creation of the HMIS. As such, the computer equipment is
to be loaned for use by the Participating Agency to collect data and prepare reports on all aspects
of the delivery of homeless programs and services. If at any time the Participating Agency
discontinues participation in the HMIS, all such loaned computer equipment is to be returned
within 30 days. Each loan of equipment will be documented with the following MOA.

                                  Memorandum of Agreement

Homeless Coalition of Polk County hereinafter HCPC and _______________________
hereinafter Participating Agency, the provider mutually agrees to implement the Homeless
Management Information System (HMIS). Both parties agree to the following:

   Will loan a Computer serial number _________________ to be used by the Participating
      Agency HMIS Agency Administrator.
   Will provide technical assistance and training for use of the HMIS software.

Participating Agency
     Will accept the loan of the Computer and use it for the data collection project.
     Will participate in the HMIS project including inputting of client information agreed
        upon by HCPC and Network members.
     Will maintain the equipment to ensure its proper use.
     Will notify HCPC in any change in location or custody of the equipment
     Will participate in the development of policies and procedures for the HMIS user group
        and abide by them once adopted.
     Will assist in developing collaborative procedures with other Participating Member on
        the system, time and resources permitting.
     Will return the Computer when requested by HCPC.


__________________________                        ____________________
Executive Director                                Date

Participating Agency

__________________________                        _____________________
Representative authorized to
Bind the Organization                                             Date

Location of computer:



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