GEORGIA MEDICAID: WEB PORTAL USER AGREEMENT

This User Account Agreement is made by and between the State of Georgia Department of Community Health (‘DCH’), and a licensed health care provider, or an entity who acts on behalf of a licensed health care provider, who has signed up for an account on this website (‘User’).

This Agreement becomes effective upon execution, and shall remain in effect until _________, or until terminated with or without cause by either party.

Pursuant to the terms of this Agreement, User is authorized to access confidential Medicaid data through the use of computer-related media (system inquiry, on-line update, printed reports, ad hoc reporting, CD reports, etc.), commonly known as the Georgia Medicaid Management Information System (‘MMIS’).

User is responsible for complying will all applicable federal and state laws, rules, and regulations when creating, accessing, receiving, maintaining, or transmitting information within and from the MMIS. Such laws and regulations include, but are not limited to, the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the American Recovery and Reinvestment Act of 2009 (ARRA) and federal Medicaid regulations governing the confidentiality of information about applicants and recipients, codified at 42 CFR Sec. 431.300, et sequitur.

User agrees to use appropriate administrative, technical, and physical safeguards to prevent any use or disclosure of information retrieved from the MMIS that is not permitted or provided for by this Agreement and by the applicable laws and regulations.

User shall only use and/or disclose information retrieved from the MMIS to perform obligations and responsibilities as authorized by the DCH and this Agreement.

User understands that, in accordance with state and federal law, information retrieved from the MMIS may be used solely for the following purposes:

• Establishing whether an individual is eligible for Medicaid; .
• Determining the amount of medical assistance, or the amount and source of third party liability; .
• Providing eligible recipients with Medicaid services; and.
• Conducting or assisting an investigation, prosecution, or civil or criminal proceeding related to the administration of Medicaid.

User understands that the use or disclosure of information retrieved from the MMIS for purposes other than those related above may result in sanctions, civil monetary penalties and/or criminal charges against violators.

User shall not disclose to unauthorized persons, nor knowingly permit unauthorized access by others to information retrieved from or maintained in the MMIS.

User shall not use the system as a locator service for law enforcement, child support enforcement, or other purposes unrelated to Medicaid.

User shall not obtain recipient or provider information for User’s own or another’s personal use.

User shall not use information retrieved from MMIS to determine if a relative, friend, neighbor, or acquaintance or public figure is a Medicaid applicant or recipient.

User understands that User is responsible for any activity that occurs under User’s personal password, login, or User ID. User acknowledges and agrees that only designated personnel shall be issued login ID(s) and passwords, which may be used only within the scope of the approved application. User's use of logon ID(s) and password(s) constitutes an Electronic Signature that confirms User's willingness to remain bound by these terms and conditions. In the event an authorized password, login, or user ID is compromised, User must notify Georgia Medicaid immediately.

User agrees to provide a written report to the DCH HIPAA Compliance Office regarding any use or disclosure of information retrieved from the MMIS not permitted or provided for by this Agreement of which User becomes aware within three (3) calendar days of User becoming aware, to include (a) the nature of the disclosure; (b) Protected Health Information used or disclosed; (c) the individual(s) who made and received the disclosure; (d) any corrective action taken to prevent further disclosure(s) and mitigate the effect of the current disclosure(s); and (e) any such other information requested by DCH.

User will not use, disclose, or communicate information retrieved from the MMIS to any third party for any purpose not in conformity with this Agreement without prior written approval from the Georgia Medicaid. User shall ensure that any agent, including a subcontractor, to whom it provides information received from, or created or received by the User on behalf of Georgia Medicaid, agrees to the same terms, conditions, and restrictions that apply to the User with respect to information retrieved from the MMIS.

The DCH reserves the right to edit, update, or terminate this Agreement at any time.

Clicking ‘Yes, I agree’ constitutes a signature of this Agreement. By signing this Agreement, I acknowledge that I have read and understand this Agreement, and I consent to be bound by all of the terms and conditions listed herein. I understand that any failure to comply with this Agreement may result in sanction, including the termination of my User Account.