Participating State Agency Program Official. The authorized Participating State Agency program official, whose signature appears below, accepts and expressly agrees to the terms and conditions expressed herein, and confirms that no verbal agreements of any kind shall be binding or recognized, and hereby commits their respective organization to the terms of this Agreement. Attachments:
1. Attachment A – Attachment for Downstream Users that are Providers 2. Attachment B – Data Use Agreement for Participating State Agency
3. Attachment C – Data Use Agreement Addendum for Downstream Users This is a Data Use Agreement (DUA) Attachment A is for use of Participating State Agencies that have executed the INFORMATION EXCHANGE AGREEMENT BETWEEN CENTERS FOR MEDICARE & MEDICAID SERVICES AND THE PARTICIPATING STATE MEDICAID AGENCY FOR DISCLOSURE OF MEDICARE PART A, PART B, PART C, AND PART D DATA (CMS AGREEMENT No. 2014-13), hereinafter referred to as “CMS IEA” for use when disclosing the CMS Data obtained under the terms of the CMS IEA with any Downstream Users that are Treating Providers. This DUA Attachment A must be executed prior to the disclosure of CMS Data and any derivative data from Participating State Agency to a Downstream User to ensure that the disclosure will comply with the requirements of the CMS IEA, the Privacy Act, the DHHS Privacy Act Regulations and CMS data release policies. It must be completed prior to the release of, or access to, specified data files containing protected health information and individual identifiers. This Attachment supplements the Data Use Agreement between the Centers for Medicare & Medicaid Services (“CMS”) and the Users. To the extent that the provisions of this Attachment are inconsistent with any terms in the Data Use Agreement, this Attachment modifies and overrides the Data Use Agreement.
