Exhibit 10.96


 


AMENDMENT

to the

PARTICIPATING PHYSICIAN GROUP PROVIDER SERICES AGREEMENT

between

HEALTH NET, INC. AFFILIATES

and

Professional Care Medical Group, IPA


 


The Participating Physician Group Provider
Services Agreement (“Agreement”), dated March 1, 1999, between Professional
Care Medical Group, IPA (“PPG”) and Health Net, Inc. Affiliates (“HNI”), as
subsequently, amended is hereby amended effective April 14, 2003.


 


HNI and PPG hereby agree to amend the
Agreement as follows:


 


1.               Addendum A to the Agreement shall be
amended to add Health Insurance Portability
and Accountability Act, (“HIPAA”) as a new Addendum K.


 


2.               A new Addendum
K. Health Insurance Portability and
Accountability Act of 1996

(“HIPAA”) shall be added to the
Agreement and is attached herein.


 


Except as so amended, all other provisions of
the Agreement shall remain unchanged and in effect:


 


IN WITNESS WHEREOF, the
parties hereto have executed this Amendment by their offices duly authorized to
be effective on the date and year first written above.


 


	
  Professional Care Medical Group, IPA

  	
  Health Net, Inc. Affiliates

  
	
   

  	
   

  
	
  /s/ Rick Shinto

  	
   

  	
  /s/ Jenni
  Vargas

  	
   

  
	
  Signature  Rick Shinto, MD

  	
  Jenni Vargas

  	
   

  
	
   

  	
   

  
	
  Medical Director

  	
   

  	
  Network
  Management and Development

  Officer

  
	
  Title

  	
   

  
	
   

  	
   

  
	
  4/28/03

  	
   

  	
  5/20/03

  	
   

  
	
  Date

  	
  Date

  
						



 


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ADDENDUM K


 


HEALTH INSURANCE PORTABILITY AND
ACCOUNTABILITY ACT (HIPAA)


 


A.           Health Plan and Provider are parties to the
Agreement pursuant to which Provider provides a service to, or performs a
function on behalf of, Health Plan and, in connection therewith, uses or
discloses Protected Health Information (“PHI”) that is subject to protection
under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”)
and certain regulations found at 45 CFR Parts 160 through 164 (“HIPAA
Regulations”):


 


B.             Health Plan is a Covered Entity as that
term is defined in the HIPAA Regulations. 
Provider creates or receives PHI from or on behalf of Health Plan and
is, therefore, a Business Associate, as defined in the HIPAA Regulations:


 


C.             Pursuant to the HIPAA Regulations,
Provider, as a Business Associate of Health Plan, must agree in writing to
certain mandatory provisions regarding the use and disclosure of PHI: and


 


D.            The purpose of this Amendment is to satisfy
the Business Associate contract requirements as set forth at § 164.504(e) of
the HIPAA Regulations, as they may be amended from time-to-time.


 


NOW,
THEREFORE, in consideration of the mutual promises and covenants contained
herein, the parties agree as follows:


 


1.               Definitions. Unless otherwise
provided in this Amendment, capitalized terms have the same meaning as set
forth in the HIPAA Regulations.


 


2.               Scope of Use and Disclosure of PHI.
Except as otherwise limited in this Amendment:


a.               Provider shall use and disclose PHI
solely to provide the services, or perform the functions, described in the
Agreement, provided that such use or disclosure would not violate the HIPAA
Regulations if so used or disclosed by Health Plan.


b.              Provider may use or disclose PHI for the
proper management and administration of Provider or to provide Data Aggregation
services to Health Plan.


 


3.               Obligations of Provider.  In connection with its use and disclosure of
PHI, Provider shall:


a.               Not use or disclose PHI other than as
permitted or required by the Agreement or as Required By Law.


b.              Use reasonable and appropriate safeguards
to prevent use or disclosure of the PHI other than as provided for by this
Amendment.


c.               Mitigate, to the extent practicable, any
harmful effect that is known to Provider of a use of disclosure of PHI by
Provider in violation of the requirements of this Amendment.


 


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d.              Report to Health Plan any use or
disclosure of the PHI not provided for by this Amendment of which Provider
becomes aware.


e.               Require contractors, subcontractors,
and/or agents to whom Provider provides PHI created or received by Provider on
behalf of Health Plan to agree to the same restrictions and conditions that
apply to Provider with respect to such PHI under this Amendment.


f.                 Provide access, at the request of
Health Plan, and in the time and manner within five (5) business days, to PHI
in a Designated Record Set to Health Plan in order to meet the requirements
under § 164.524 of the HIPAA Regulations. If Health Plan and Provider mutually
agree, Provider may provide such access directly to Individual, provided that
such access is provided to the Individual in the time-frames set forth in §
164.524 of the HIPAA Regulations.


g.              Make any amendment(s) to PHI in a
Designated Record Set that the Health Plan directs or agrees to pursuant to
§ 164.526 of the HIPAA Regulations at the request of Health Plan in the
time and manner within thirty (30) calendar days.


h.              Make internal practices, books, and
records, including, but not limited to, policies and procedures, relating to
the use and disclosure of PHI created or received by Provider on behalf of
Health Plan available to the Secretary, and to Health Plan, if requested, in a
time and manner designated by the Secretary, for purposes of the Secretary
determining Health Plan’s compliance with the HIPAA Regulations.


i.                  Maintain for a period of six (6)
years an accounting of all disclosures of PHI that are required to be
maintained under § 164.528 of the HIPAA Regulations. Such accounting will
include the date of the disclosure, the name of the recipient, a description of
PHI disclosed and the purpose of the disclosure.


j.                  Provide to Health Plan in time and
manner within fifteen (15) business days, information collected in accordance
with Section 3.i. of this Amendment, to permit Health Plan to respond to a
request by an Individual for an accounting of disclosures of PHI in accordance
with § 164.528 of the HIPAA Regulations. If Health Plan and Provider mutually
agree. Provider may provide such accounting directly to Individual, provided
that such accounting is provided to the Individual in the time-frames set forth
in § 164.528 of the HIPAA Regulations.


k.               Make reasonable efforts to implement any
restriction of the use or disclosure of PHI that Health Plan has agreed to
under Section 4.c. of this Amendment.


 


4.     Obligations
of Health Plan. Health Plan shall:


a.               Provide Provider with the notice of
privacy practices that Health Plan furnishes to Individuals in accordance with
§ 164.520 of the HIPAA Regulations.


b.              Promptly notify Provider of any changes
in, or revocation of, permission by Individual to use or disclose PHI, to the
extent that such changes may affect Provider’s use or disclosure of PHI.


 


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c.               Promptly notify Provider of any
restriction to the use or disclosure of PHI that Health Plan has agreed to in
accordance with § 164.522 of the HIPAA Regulations, to the extent that such
restriction may affect Provider’s use or disclosure of PHI.


d.              Not request Provider to use or disclose
PHI in any manner that would not be permissible under the HIPAA Regulations if
so used or disclosed by Health Plan, unless such use or disclosure is necessary
for the purposes of Data Aggregation or management and administrative
activities of Provider under the Agreement.


e.               Pay Provider $0.25 per page for all
records and documents that Provider is obligated to provide to Health Plan
under the terms of this Amendment.


 


5.               Termination for Breach. Upon
Health Plan’s knowledge of a material breach of the terms of this Amendment by
Provider, Health Plan shall, in accordance with the notification requirement
and cure period set forth in the Agreement, provide an opportunity for Provider
to cure the breach or end the violation. 
Health Plan may terminate the Agreement if Provider does not cure the
breach or end the violation within the cure period set forth in the Agreement.


 


6.               Future Confidentiality of PHI.
Upon the expiration or earlier termination of the Agreement, for any reason.
Provider shall return or destroy all PHI received from Health Plan, or created
or received by Provider on behalf of Health Plan that Provider still maintains
and retain no copies of such PHI; provided that if such return or destruction
of PHI is infeasible, Provider shall provide to Health Plan notification of the
conditions that make return or destruction infeasible and shall extend the
protections of this Amendment to such PHI and limit further uses and
disclosures of such PHI to those purposes that make the return or destruction
infeasible, for so long as Provider maintains such PHI.


 


7.               Amendment. The parties agree to
take such action to amend this Amendment from time-to-time as is necessary for
Health Plan to comply with the requirements of HIPAA and the HIPAA Regulations.


 


8.               Survival. The respective rights
and obligations of Provider under Section 6 of this Amendment shall survive the
termination of the Agreement.


 


9.               Interpretation. Any ambiguity in
this Amendment shall be resolved to permit Health Plan to comply with the HIPAA
Regulations.


 


10.         Conflict of Terms.  Whenever the terms of the Agreement and this
Amendment are in conflict, the terms of this Amendment shall control.


 


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11.         Other Terms Remain in Force.  Except as expressly modified by the terms of
this Amendment, all of the terms and conditions set forth in the Agreement
shall remain in full force and effect.


 


12.         Effective Date.  This Amendment shall be effective on April 14, 2003.


 


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