+----------------------------------+---+---+------------------------------+
| ##### Di                         |   |   |                              |
| vision of Public Health Services |   |   |                              |
+----------------------------------+---+---+------------------------------+
| *Office of the Assistant         |   |   |                              |
| Director*                        |   |   |                              |
+----------------------------------+---+---+------------------------------+
| 1740 W. Adams Street             |   |   | JANET NAPOLITANO, GOVERNOR   |
+----------------------------------+---+---+------------------------------+
| Phoenix, Arizona 85007-2670      |   |   | CATHERINE R. EDEN, DIRECTOR  |
+----------------------------------+---+---+------------------------------+
| \(602\) 542-1023                 |   |   |                              |
+----------------------------------+---+---+------------------------------+
| \(602\) 542-1145 FAX             |   |   |                              |
+----------------------------------+---+---+------------------------------+

###### Attachment 2

NOTICE OF PUBLIC HEALTH CERTIFICATION FOR TOBACCO TAX PRIMARY CARE
PROGRAM AND EVALUATION UNIT

[PLEASE NOTE: FEDERAL LAW DOES NOT RELIEVE YOU FROM YOUR OBLIGATION TO
PROVIDE THE INFORMATION REQUIRED UNDER ARIZONA LAW]{.underline}.

Arizona Revised Statutes Sections 36-2907.05, 36-2907.06, and 36-2907.07
require that the contractors for the Tobacco Tax Primary Care Program
and Evaluation Unit ("Program") submit information required to conduct
Program evaluations for the purposes of public health and health
oversight activities, including but not limited to:

> 1\. Random sampling,
>
> 2\. Audits,
>
> 3\. Data aggregation,
>
> 4\. Reporting,
>
> 5\. Research,
>
> 6\. Cost benefit analysis, and
>
> 7\. Claims processing.

HIPAA permits disclosure of protected health information and related
records to the extent that such use or disclosure is required by law and
the use or disclosure complies with and is limited to the relevant
requirements of such law. 45 CFR 164.512(a). HIPAA also allows
disclosure for public health activities and health care oversight
activities. 45 CFR 164.512(b)(1)(i); 45 CFR 164.512(d).

This disclosure is required by law and, as such, the contractor is not
required to make a minimum necessary determination. 45 CFR 164.514(d).

Arizona Revised Statutes Sections 36-2907.05, 36-2907.06, and 36-2907.07
mandate that the Arizona Department of Health Services ("Department")
award state funded grants for primary care services for low income at
risk residents of this state and to indigent or uninsured (e.g.,
non-Title XVIII, XIX, or XXI) residents. Because the principal activity
of the Program is the making of grants to fund the direct provision of
health care, this government-funded program is exempt from the
definition of health plan under HIPAA and, thus, is not a covered entity
under HIPAA. See 45 CFR 160.103.

The Department and authorized representative(s) of the Department
certify that protected health information and related records collected
and received by this request will be used solely for the purposes
allowed under HIPAA and stated herein.

Arizona Department of Health Services

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Authorized Individual for Program Date

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Printed Name and Title