Notice of Publication of Common Agreement for Nationwide Health Information Interoperability (Common Agreement) Version 2.0, 35107-35182 [2024-09476]
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Federal Register / Vol. 89, No. 85 / Wednesday, May 1, 2024 / Notices
purposes of publication in the Federal
Register.
Technology, Department of Health and
Human Services.
Trenesha Fultz-Mimms,
Federal Register Liaison, Centers for Medicare
& Medicaid Services.
ACTION:
[FR Doc. 2024–09426 Filed 4–30–24; 8:45 am]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Office of the Secretary
Notice of Publication of Common
Agreement for Nationwide Health
Information Interoperability (Common
Agreement) Version 2.0
Office of the National
Coordinator for Health Information
Notice.
35107
Coordinator for Health Information
Technology, 202–664–2058.
This
notice fulfills the obligation under
section 3001(c)(9)(C) of the Public
Health Service Act (PHSA) (42 U.S.C.
300jj–11(c)(9)(C)) to publish the trusted
exchange framework and common
agreement, developed under section
3001(c)(9)(B) of the PHSA (42 U.S.C.
300jj–11(c)(9)(B)), in the Federal
Register. This publication consists of
the following document:
SUPPLEMENTARY INFORMATION:
This notice fulfills an
obligation under the Public Health
Service Act (PHSA) that requires the
National Coordinator for Health
Information Technology to publish on
the Office of the National Coordinator
for Health Information Technology’s
public internet website, and in the
Federal Register, the trusted exchange
framework and common agreement
developed under the PHSA. This notice
is for publishing an updated version of
the Common Agreement (Version 2.0).
SUMMARY:
BILLING CODE 4150–45–P
FOR FURTHER INFORMATION CONTACT:
AGENCY:
Mark Knee, Office of the National
Common Agreement for Nationwide Health Information Interoperability (Common
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Agreement) Version 2.0
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Federal Register / Vol. 89, No. 85 / Wednesday, May 1, 2024 / Notices
35109
COMMONAGREEMENTFOR
NATIONWIDE HEAL,,_. . 1,FOUIATIC>N:IN"l'E~OPERABILQY
vmsioo2.t1
- ~ • ~ •....idlid•~·.,·ai·~•*•j'f~w.,..~~~•··~·
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. ~ -.. ~~gf!t](t)afthel'lMt...... ~ # f i i t t h l ! ~ - · ··~-·t'iw~
lnfoii~t~•11,·~·t111dll!~aftllioN~··QlCJldii.iib:lf·tarHl!alth··iiifcrrfflillilm~
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pjilllil:lnb!ml!t~lii'illlinthl!fellinl~,.-~ai,ee.1e1t~USC:300j~).
35110
Federal Register / Vol. 89, No. 85 / Wednesday, May 1, 2024 / Notices
.The Common.Agreement
for Nmionvride Healtft Information Interoperability
This Common Agreement for Nationwide Health fnformatioo Interoperability (the
"Common Agreement:"'} is entered into as of the CA Effective Date, by and between The Sequor.a
Project, ioc, a Virginia non-stock~ acting as the current Remgnized:Cooidinllting
fntityEfasdeflned bekw#(tlle "'RCETMj and _ _ _ _ _ _ _ _ _ _ _ _ ___,a
_ _ _ _ _ _ _ _ _ _ _ _ C"S~)- RCf and.~ory may:afsobe referred
to herein indnridually as a "PilftV" ormleaively as the '"Pama"'
BBJTAlS
WHEREAS. Semon~ dthe 21st Century Cures Ad: directed the u_s_ Department of
Health and HUfflilln Services rHRS"'J Nmonat Coordinatwfor Heillth Information Tedmologyfu,
"in c:ollabaration with the Niitional Institute of StandardsandTedmology and otheneievant •
agencies within the l}epiHtrnent of Health and Human Services, for the purpose of .ensuring full
netwofk-m-nenvork ~ of health information, convene p~-pnvate and public--public
pannefSbips: to build consensusaml develop of support a trum:!d exchange framewmk,.
indudinga common agreement among health information networks nationally" {the "Tnmed
Exchange frarnewort and COmmon Agreemerit"'-or TEfCASM);
WHEREAS. this Common Aweefflent {indmlingthe dm:umems inmfporatm herein by
reference) iU:he a>mmmu1greement developed pumrant to Section 4003 of the 21:s.1:eenrury
CUresAtt;
WHEREAS. The Sequoia Project has been selected by the Office of the Nmooat
Coordinatar for Health lmoonaticm Tedmotogy ("ONC"} to serve as the Ref for purposes of
implementing,. maintaining, and updatingttlis Common Agreement,..induding the Qualified
Health mformatiooNetvmrt:TM f"UHIN-, Technical framewort:, as wen as managing the
amvmes associated with. ffieaesignation of interested health infbm!ation networts("HINS") as
QHINs fas definedamlset bth mthis eommoo.Agreement);
•
WHEREAS. Signatory wishes to be Designated as a QHIN and hils completed the
application andtesting process towardsui::h Designation;
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WHEREAS. Signatory must, amang other mndi1ions setforth in th1S COmmoo
Agreement, agree to be bound by thetemlS of this Common Agreement before ~ory may:
b e ~ as a QfflNand, upon signing this CommooA.greement, S~ory agrees tn be so
bound as a Signatory and asa QHIN, if s o ~ as the case may be;
35111
Federal Register / Vol. 89, No. 85 / Wednesday, May 1, 2024 / Notices
••JHBUQR£.cm~.ornrmn:ua1.p~set{Dtffi·lleffln·•atidotbtr
~and~lua~~c~~~pt•·•nd~•.~~u.•~ · · ~
theP~iltt~tobe~~~-agreeas$el~bekrillf~·
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AGE:Mffit •
t. . • ~ .... ~ t ~ ~ · · ·
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~tiftenns.•~·~~~~~~li1dr1~¥it.~.•~.~
··~.·~·~·•dl"··~.•·~11e·~ltiiJ,sh.Jff.•~~tciretertosuch
~felUlillmn,ar~ilSJnaJbea,ne.mtmtroin~me:to-time..
•
1Deanil1g~.~.·blel~"•·Vlffierea~~.n:fudes.CJhf!Jj[tn(JretiJAl~toa
·~·taw:.~l~,#~,locilt~triilal~.• a~~~ttte.,ill.~•·
and~~totheS11ltj~~.~•. Fort~eiMlidariteofdpubt., ~ .
agen:iesareontysubjeatofederail.wt<
• •• •
~.·al.Un~~~·•-~•ttieacij;Jisitim'l,
~;ar.Oi$f;lc,suie•oJ.~mdividua11y1c1emif.illR•1n~•f'itilirted
byan~~rthatc~isesffiesemrityQt~d'theunenaypted
. ~rddmfiable ~atioi:i
~Ali~=~*~ai~to·•5Q(h·.·tet·,n••stfl1tcn1G$:
~~~mt{Wl:.aaJl1lfacf,,•~•·orotber·arrangement
·•.~•.~.·~implefll~~i~ttons:~bedlritlun45Cfll§
t&U.14(a}andlti4;~e>. as~bfe.
•~ ~ ~ ~ ~ m d c i i t e d , . t t i e t o ~
~fot~Heaithl~•·~~--(piHTethmtal
fra~.tti1f),all~~rat1ng.•Pmc2du.res~1•••adler·
•atl:at:hmero.:m-,ani:I ~i~~- ~~nee.
·~•~·ttAJ~0ate:tc:cij!1~•n~asa.Ql:ffll
prkltt~ihe•l-.m~~·Oilte~~rtt~t~~.·•dc··Ji)if~
·was·.~•at·•llQHIN•.a1ter•~·~~··~iflfflthedate.U.tbe·
ICfaet.UteSthe•Common~mentto•whimSigniltorf: isaP.artys.
~ m i i a l ~ i i l P / • ~ · - i · ~ ~..~·····
•tt1io~.bJ•Q~~t1i~•••~t€~•.•~•u~tttbt:aI
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a.m'lfldential•mttw:'e,andii:discmedto•aD.Redpie~flUhi.liirifto<lr'.intarlrieclmn••
35112
Federal Register / Vol. 89, No. 85 / Wednesday, May 1, 2024 / Notices
with a framewmt Agreement. for the avoidance of oowt, "'Confidential
fflformation" does oot indude ·eBectrnnii ~ health mfcrmatioo {ePHJ}, as
defined in a framework ~ t , tnatis subject to a Business Associate
Agieementorothel' p ~ o f a Framework Agreement.
Notwithmlnding any iabeh:o the mntrary, "Confidential tnfmmatiffl"' ooesnot
include any inmrmanootnat: ti) is orberomes known pubfidy ~ n o fault of
the a Recipient; or (ii} is learned by the O Recipient from a third pany that the Cl
iedpient reilSOriably believes is emidedtomsdose it withoot resml:tioo; or Ciillis
already koovm to the a Recipient before receipt from the a Disdom; as shown. by
the a Reripient's written reconfs; or (iv) is wlependently developed by the Ci
Redpientwithriutthe use of or referencetothe a O ~ s Cmmdentiat ..
information, as shown by the a Recipient's wrirtm reoo~ and was not subject to
·~-restrictions priormre.reipt of sum mfufmancm from the a Dimm:ec
G:mf"Jdentillil mtommion {Cl) DisdORC a person or emity .tbilt d5ooses
Ccnfidenffill fnfurm.moo.
Comidentillil ~ · ( C i t ~ a per-soo or entity that receives Comidemiaf
mfonffimon.
~ ~ = t h e ~ i services provided bya QHIN., Participant, or
~ to its hrtidpants and SU~thatfadlitate TEfCA &mange
and are conmtent with the requirements ofthe then-applicable QHm Temnirat
framework.
vr·
Com:nw:t: the Contract and between Tue sequoia Project and HHS, or, if
appitabte, a successor ~ t bet.ween TheSeqtroia Project and ffl-5 « a
~ agreement between a different RO: and HHS.
Covered Entity: tmttte meaning ~ t o sum tam at45 CFR§ 100:1m..
· ~ m y Comlm:thecoondl established by the RCE to enhance cyberserumy
commensurate with the risks in TEFCA Exmange1 as more fully set forth in an SOP.
Designated Network: the Health lnfmmiitim Networtt that ~ r y uses to offer
and prmride t h e ~ Network Seniices.
Designated Network 6ovem11!'Klf! Body: a representative and participatory group or
groups thilit approve the processes: f« fulfflling the Gmremanre ftn::m:.lffi and
~ in.sm:h~e:f~furSigniltory's ~ N e t M H .
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Federal Register / Vol. 89, No. 85 / Wednesday, May 1, 2024 / Notices
35113
DesipatedN~k~theConn&th!ity•Senrit.'es.«.~.Services.
··~ationfmdlldingks.~m8ninp.'1>tsigftate," ~ r . . i
m!Ei1ifS~T;=
.
~~~=:~~~::
s::.:r:rnv .·
•otherorp~nal Olftedlnic:af ~.requl,;ed bJ!hl!' Qtf .-an;apptitilble
·st>P..
~ • e t i m : m - • ~ ~ ~ -..~~,nc1··
•-~~'!he r:e1ease_ 1ransfer:. ptoviskln ofam55to... o r ~ . in·any. •
mannerof l"EFCA inbmatioo (Tif~the entity hOldiqthe il'Jloimatmn:·
. Discower (ilictridiftgits ~tile llltimings '"~ffflii ..~Dfff.the
·.·•.w~:::~==·:e~=~=:=~=
. Qf$Ubpartidpanr.
•
•
•
•
•
•
~inatoryM&l1111eCanyattoro~that:isir.consistenUyt.ltenaroottilren
~•it~-ltmm~.
..
.
.
.
··~:{itadi~aboutanypnwisionofthisCommon,~ent.,
ftiludinganySOP~theQTf,,andailQtheriittmnen~exhibits;andartifam
.·iioonporatedbf ~rent:e; otiii)a con~ armmplamtabouttheactioM,ariifW
.·::::::=:tatbrJ:.•ttie•.ntt. anr mhl!i<lHltt.ar:·~.aHIPisP&tici~sl
··~~~Pto~:·1t1e no~bindq:bispmetesduw,npwcesssetfonhin
anSOP.
··=';~=--=~atimifePHijihil1dtierisear1ing~tostidt
·~Puqmsetsj MXftst:the re~;as~•bf a Framework.
Agn!ement, mdodmg the• apptinibteSOpts~ mratt.lltlsn'limon, Query,; llii; •
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35114
Federal Register / Vol. 89, No. 85 / Wednesday, May 1, 2024 / Notices
Enmi.ewark Agr'eemem(s}: with r ~ to QHINs, the Common Agreement; and
with respect to ,a Pa.rtiitdpant or SUbpart\ciparit, the :Pa:rtidpilnf/Subpamapant Tennis
Of Paitidpatmn (ToP).
fHIR Endpoint: has the meaning assig)ned to,such term in the Hea.tth left\! Seven
llntermi.tional 8 iHL79 ) fast Healthalre lni::ercperabiility Resouite.5 (FHIR.9 1
Specif11Catiictl aviRlable at https:/fhl7.a,g/fhr/r4/, as .wdi.spedfkatian fflitY be
amended, modified or replalled.
•
•
•
RC Rufe: the Heallth Bread'! NotificatiOn Rule promulgated by the federal Trade
Olmmimon set fmllh at 16 Cfl Pi!rt 3Ut
6werning Councill.: the permanent governing body for actMtiles conduct:9· ul'ldel'
the Fraln\eWOrit Agreements, as more fu/liy desai1bed in ttae appl1icatlfe SOP•ls),.
6owanmem Benefia Determitaticm: a detenmnation made by any qem::v,
instrumentii!llil:y,, or other· unit of the fede1ral, State;. foclll, or tribal l(M!mme.nt as to
whether an lhl:ividual qualifies torgcwemment benefits. for any purpose other. than
heillth (iilfe (e.g., Sm:ial S&Ul'il:y dis:abiitV benefits) to the fX!teflt permitted by
Aipl)4icable law. Discmsure of' n for this p.irpase miJJf require an 1mthoritzatmn that
mmpl.k5 with AJJplit:able Lillw..
•
6wernment. Health Om! Enthy:: ilfl¥ aeency, iimtn.lmentilllity, or other unit of' the
federal, :State, klcal,, or 1::ribal govemmenna the extfflt that It provides health care
services (e..g..,, treatment) to lncli\liduals tlut only to the extent that. it is not acting as
a Covered Entity.,
•
Gwernamie 1Funl:tiom: the fun<::oom:, attiMi'lies, and responsibilirlies of the
lle:spted Network Qwemance Body as set mirth in an applicable SOI'.
60ll'ell'11t11'Hle Services: the goyemante fum:Jtmns desaibed in. applicable SOP{s).
wl1iic:h are pel'ft>rmed by ii QHUfs Designated Net.wort Gmtemill!'IR Body fm its
Participants: and SUbpartidpanltS to facilitate lEftA El«:hiiinge in ,compliarn::e wltlil the'
thl:!111-applicable requirements of the .framework .Agreements..
Heatlh.C1re Provider: meets 11:he definition of suc:t1 term in. ,either 45 CFR. § 171.102.
or mthe HtPM lutes at 45 Cffl § 100.103.
Healffi Jftform1;tion Nletwmt (KIN}: hast.he meaning assigned to the term "'Health
ilnft:lrmatiicn Network or Health lnft!Dniii!tion &change" mthe infm'matkm blodci!nl
reaufations at 45, cm § 111.102:.
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35115
•.•ffltM.6iltes:~regulii~setforffia1.1ts~hrtsl.i{1&2;andii4~
·•ffBl~.~Rute~·tJJE·•~seiti'lh'at4st:Rl.·r,.miGDanc1164.~tts
A•i'lf.tt::
•
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tu,M~ ...=•·reau•msti~at4S~Pan·•iw.an11•.ean:1ffal.
Slmparit:
~•···~~*·~s~tQi:;de•,.~~•·pUbl~rtot~.
:zotttie.~·•~·intfle~l·1t~.
1111lwidu~·mffie•i'neilnfflli'·~··tosuttitennat45CfR§•171.202(a~)..
.~
~.~·•~•~•.~~·.~:il#t~~~~Ofil
. ~. af.~lndivtdually.Idehtitiable.lnfoimiil:ion.•ntilinfainedibyan·l/4S•
...
lndiwidum:~~•~tJAS·•~·eathttl-lrt~~ntai'lf.t
.
~ t t m t lilffef$Wnnilua1~ SlmrilE$ (IAS)•. ·. • ·. . . . · · •··. . •··..
'
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. ·11~,~~··tlMJ:ttiese~~~.~~.•·ij,aQtili;.
,~•or~tttta1·hiis•a•c1rea~1··re1~1P·'Mffi··suti
.~@•wtiidt•~•Q}IIN,P~t,.otS~.as~Pfditi!li~·•.~••m
sa&fy'thiitf mciivldUill's~bililyt1>\15eTI:~&dli~tba~.. ~obblin;•or
tr.nmita:mpy.afthatlndiridual'sRequifedlnfurffliiltiutl.
·w•~aitMP~s•-~rtit,,.tuf~iril'lt~.~
·•tjij~ft;um~~~··iitm~WiihttietM.
ll~ldelllfilbleliitoimalion:•infmmlllmnthatid'ehtil'iesillnlmlMduafer
vnth.~towhllil•reJS:a~basis1Dbe~.thatthemfonnatim·
amldbeusedtoidelntifyan ~
·iltt.jfawgNjde:aNode~llihidla·QHlt1.,~•~
~
...~t'or~Exdi•• · · · · · · · ·· · · ·· · · · ·
··~e:1tedimtatsys1emttia1:~tamrdleci~or~bva@ij,
~~·•ar~anc1u.1·.s~in·the!·RCE~~-
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Federal Register / Vol. 89, No. 85 / Wednesday, May 1, 2024 / Notices
Nmt-ltlPAA Ermty (NHE): a QHIN, P:i111klipant, or SUbpi111idpant ttlat is neither iii
caitered Entity nor a Buisiness Am>l:iale as defin,ed under~ HfPM Rules Wi!:h
negard to activities und.er .1 Framework Agreement. Ta the exrent a Q!HIM,
Particip.ant, or Sut:Jpart!idpant is Hybrid entity, as defined m45, CfR: §.164.103~ sudh
QHIN, Pi111idpa.nt, or Sut,paniqpant shall be coosidered. a Non·HIPM Entity Mth
respect til TEFCA. Exd1anee activities related to such QHIN, Participant, or
Stlt!pill1icipam:'.s non-c,weretl cmr!fHlnB'lts.
a
mK:: the U~S.. Deprnment of lieal:th and HUffliln Sienlires Office of the 'l'fational
QJordina1)ar for Health lnfi:>rmatiOn Technology.
.Partiidpimt: to ·!the· extent perm.bed by ,ill!pplkitble SOP{s), a. U.S. Entity that has
to use
entered inte> the laP in a l~ill.fy IIDndiq contract Wlith a QHH!l
the QHIN's
Designated Networt .Se:rvice!i .to pa!rtidlpmte in TEFCA Exdl.ii,ee in mmpUance Mttl
the Tofil'~
•
Partiidpuit(Slid:lperm:ipalilt Qwcus;: a f!Orum established pum1ant to an applicable
SOP(s}, the· ~ e ofwhidl is·~ the Participants. and su,.artidpimtS to meet and
disat55 i5Sues of interest: directly 11!:titedto TEFCA 0:Chiimge ,imd. relillted act:lwties
under the fr:amewmt Agreements.
Panidpui~dpalilt Tmns of Partilr:ipniH ,IJoP): the. requirements. set f'Clfllh
m Exhtit. l to the· Commm11 Agreement to which: QHINs must icffl'lltracwally oblijf.ate
their Pa·rtidpa1nts to qree; to. which QHINs must a:mtactually ,obligate their
Paniil::ipants to amtrac:tUilily oblig,ate theirsut:ipal'ticipants ,imd 5Ubpar1icipants of
the Subpill'tiapal'lts to agree, morder to participate mTEFCA. &:clhai11ge including the
QHIN Te.mnicat firamewort (QTF), all aiN)litiilble Standaird Opemiq Pmced1ures
(SO.PsJ, aind iill' ·llttler· attild1me11ts, •Dhibits, and artiif'ad:s incarporated therein by
reference.
lJ>iili;Slllrougb Nooe: ai Node that i!i l"llati'ier an lniltliatiq oor lespondiq Node·. and
ttil'C!Ugh wtlich ,a QHiN, Parlkliparn:; or Subjpill1iciipant transmits transac:ticns 10 imd
from h1itiat~ and Responding Nodes, mcluding all'IY llttler senice!i it proirides.
Priv.1i:y and Semrily Nodce: an IAS Pnwider's ,own sqpplied written pri!Jacy and
seollrity notiice that contains the infurmatmn required bf !the applicable SOP(s).
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Protected Health lnfOimat:icn f!Ptl}::.hlls the meaning &llfled to, sl.1d1 term et 4:5
Cf'R§ 161U.03.
Federal Register / Vol. 89, No. 85 / Wednesday, May 1, 2024 / Notices
35117
Public tie.Ith Auth,grily: has. the rRMillg assigned to su.dh term illt 45 CFR §
1:64.:5(1]._
•
QHifft Tedmnl f:.rsmework (QJFt: the mo.st ret'ellteffectiwe veriiiliJn of the
document thillt contains the technical, funttiooal, pri'llaqr,. amhecuri:ty requirements
forlEFCA Exdl;;n11g:e.
Qualified Hedh ~bmaoom Network (QHIN): to the· eldent pennitt:ed by
appbbie SOP(s), a Health Information Networll that.is a u.:S.• Enll:it.y thillt ms been
Des~ted by the RCE and is ii Painy to the Common Agreemett coul"lltemgned tv,
fhe,ICE.
QHIM C!M:1JS: ii fbmm estaiMished p1Jrs1.Snt to an appHCiilble SOP(s), the purpose of
whkh is for me QH!Ns n,, meet and discuss issues af interest directly related to
TER:A mha•e and related act:Mlties 'Under the fri1!1'111ework Agreements.
Query(ies) (induding its m.rrellitive 111esftenses "Queried" l!ltlOd :"Q.uerying."'J: me
att of asking for infi:mnatioo through TEFOI\ filtharige.
BCE Diteeitoty Semce: ii tethnital sen.iice provided bf U'le ICE that enal:lles QHll'lls w
identify their Nodes to enal:de TffCA EKhange. The requirements far use o,f,
1oousio11 m., and maintenance aft.hie RCE Direttory Sef\liO:! .ii!lre setfnrth m the
framework Agreernents, Qlf; ilndapplitable SCPs.
Retogiized C:Oontm:11tiq E11,1ity (M:EJ: the entity .selected bl• om: that entefs intO
the Common Agreement l\l'ith QHINs in ordert:o impose, ,at a mimmum, the
requirements ofthe Common Agreement~ imklc:Hne the SCP!i and the QTf, on the
QHINs and ad~inister such requirements on an o~ng basis. The ru:::E.isa Party ·1tt1
ttle COmmon Agreement.
Required ilnfmnuoon: the Elec.tmn.ic 'Health Information, as defined m 45, C:fR §
111.Ui2, that iS (w) maintained in a Respol'li!lifll Node bit anv QHIN, P,i!Ftic!lpant, at
•Subpillroopant. prior to or duq ·the term ,of the applicable Framework Agreement
and (ii) relevant fer a required XP Code, as set tonh in the Qtf or an applicable
.SOP(s).
Responding Node: a Node through which the QHIM,, Pa.rticiipant~ or Sut:Jpartiicipant
Responds to ii reanred tramai:tmn for TEfCA Exdtar,ge.
Respoose(sJ (incruding its ,tom!.lstive lm!S/llen:ses "'Rspomls,.. "R:espondtd"' and
'"Respo~:. the act of a::,n:NJ'dq; me in!l'onnatian mat is the subject of a Query or
otherwise transmitting a ll'leSAge in response to a Query through TEfCA Exdtaflle.
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·~~iki;f~
•::riit::tli?.~~IIB~~•-:'t•arid·~•~fo~•~~
E:t:tJA•
·.:~~:.r~==~~,~J;•·~·~~.-•••
=~•~~
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;--,-li
~~-=:Efitm,ii:·
fQPAAIWesri~~t.•~•·
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35119
peBOn aairq; witllin their scope of .n11ttiorit:y. {ii) was made to
al'IIIJther Wol"k:fo'rce Member er person acting under the al.lthomy
of iiu11v QHIN,, Patoopa.nt, or Sl.lbparticipant, and ,fiv) does net
R!Sll.ltt in further acquisition; acass, Use, or rnsdmure. in a manner
riot. permitted ,undef Appficablle: law illl.d the framework
Agreements.
A Di!Sdosure of n where a QHIN, Participant, or Sul:lpmilipant hills
a: good fa:iith belief that an 11nautoom.ed person to whom the
Dis:dosure .was made would not reasom~bly hiM:!'. been able· to
retam sum irtmm1ticn.
fc)
A Disclosure of TI that has been de-identmed in acDmdan.ce with
the standard at 45, CfR. § 164..514(b)L
(ii) Other seruriity e\!el'lts (e.,g.,, ransomware ,1tta::b), as set fmth ifi an SOP, that
adllersetr .affett a QHHfs, Partiqpant's, or Sul:lpairticipant's partcipation in
TEFCA flcchange. •
•
Threst Condition: (i) a breach c:1f a ma.terial 1pmvis1iol"I of.a Framewm1k Agreement
.that has riot been cured 'lll!itimln fifteen (15) days of recei11mg notice of the malrelial
brei!lth (or such other period of time ta Which ·the Parties hit\l'le qreecl), which mmce
shall mude such •5ipecmc infatmatian about the breach that the Ra has aa:abde: at
the time of the l'lil:ltite; ortii) a.TffCASecuritr. Incident; or (iii) an event that RCE, a
QHIN, lits Participant,, or tileir Sutiparticipant hais: reamn to believe will disn.1pt
•nm-mar TEfCA Exdlang:e, either due to attual compromiSe of or the need to mitigltte
demonstrated vulnerabi.llities in systems ,c:1r datai of me QHV-N, Participant,. or
Sutipartk:ipimt, as· appiicable, or could be replkated mthe 5\ISte:ms,. netwDl'lks,.
appl!kaoons;, or data of another QHIN, Participant. or Subpartiopant; or (ivJ any
event that: ,COUid pose a risk to the. interests .Df Mtian,111 security as dir:etted by an
agency of the United Sll:iltes government.
(bl'
Tnmsitioo1rl Cm.mdl: the interim go\"eming body for actiwtiies conducted ,under
framework Agreements, as moll! fully demilbed in the appl1ical:!le SOP(S)..
United States:. the fifty l'.50J Sl:a.teS,. the Dstritt ,Df Coh.1mbia, and the temtmie.s ,ami
possasmns ,Df the United States including. without imitation., all miita"1' bases or
other mifit:il,v instillilations, embassiies,
consulates operated by the United States
~ent.
n
U.S., Em.iiy/Enlide11: any c:orparatiffl; liimlted lli'abffity oompany, partnership, or atlter
legal entity that meets an of the foJIOWing requiremenu:
(i) The entity is organized um:fer.tlre laws of a :stat,e ou;ommonvreaM of the·
United States or the fedefilJ law ofthe United States and is wbject to the
]:uriS;dict:ilofll of the United States illl'ld tJhe State ar ,tmnmonweait:h under
which it·was formed;
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Federal Register / Vol. 89, No. 85 / Wednesday, May 1, 2024 / Notices
(ii) The enmy"s principal place llllf busine6, ,i!!l determined 1.1nt:1er federi!!I
• com1i'imn law, is mthe United States; and
•
(iii) None of the ent:ilty'!ii di1recto1S., aflicers, or e:lllerutives, .md mme ahhe owners
with .a five percent •CS%} or greater iinterest in the entity, are liSl!:ed on the· •
Speda#y Desigrmted Ntltiana& and lloc:k,ed Pemms: list pubiisbedl by the
Ul'lllte:I States Department of the Treiasurl(s Office of Foreen Asset Control or
on the United States Department of Health and Human Semc:es, Office of
:lln~ttor Geneml"s Ust of&.dwed fmljwrlim&/Enttties.
Use(st ~im::iud"q oorrelatme uses/tenses, such as. ''Uses," ''Used,'" and "Using"):
with respe.tt to Tb, means the sharing, effl{Pkl¥ment, .~plic:iilll:lml, utiizatit:m,
examination, er aiulysis of sum mfGnfflltioo within .an entity that maintains suoh
i.lnfmmatkln.
U.S. QJ.talmed P.ermin means those individuals who are U.S. niltklnill.s iilni:I citizens at
birth as defined in 8 USC 1401, U.S. natiooaRs INt not ciliens, of the United States. at
birth as defined in s USC 1408, lawful permanent residents of the. United State.s as
defined in !the lmmiigrattoo and. Nationilliiq! Act, and norHimmjgrant: aliens who are
hired by a U.S. E:milty· as an employee m a• speciillty occupation pumJant to an H·18
Visa.
Wlll'kfvtce Melnlberfst: ,11ny en'lp!oyees, 'll'Dli:mteers, trainees, iill'ld other persans
whose: mnduct, in the. pedmmance of wor1k for an entity, i!i under the direct control
of such entity; whetherorootthey ate paid by the entity.
XP Code: the •Clode. used to identify the. •XP in any gi ven transilCticln,
appliciable SOP(S).
1
1.2
as .set. ford1 in the
O:lmmm ,Aareementlermiinobgy.
1.2.1
RefefenGes to Siggatonr and QHIN:s. M .set ftlnh iin lib defiiniticn and in the
immdlX:ti:ll'Y [Pilriilgraph of this O:lmmari Agreement;, the term "'Signaw!V" is
wed to refer t:o the .specffic entity ihm: is a Party to this Cammon ~t,eement
with the RCE. NP/ and all riigh'ls aml ,01J1i1iltk.lns of ii QHIN stated herein are
binding upon Srgmnmv as of the CA Effective Date i!llml iilR! also binding upon
all other QHiNs. Reftlrences herein to "'.other QHINs,,....another QHIN.,.. and
sirnillar SIUd! terms are used to refer to any and all .other •tlfpnizations itntt
haire.siigned !the Common Agreement with the RCE.
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1.2.2 !intentic:maHy Omitted.
Federal Register / Vol. 89, No. 85 / Wednesday, May 1, 2024 / Notices
35121
u ..3 Gma:aJ Ne gt Cpmtrug:iigg for the avom.mce of dauttt, a reference to a
spoofic section of the Commoo Agreement iin a p111rtitular se~ does oot
mean that other sections i:lf ttm CommanA1reemem that expressly apply to
a Q.HIN are imppitable. A reference: in this Cornman Agreement rto any law,
any r~lati1m, or to Appiicablle law mdudes any amendment, modffication
or replaitementm such law. regulation,. ar Applicable LM.
12.4 Terms of Partjdpation. Silgnat:my shall amtrac:rualty obll•eate Its Pritipants
to comply with the ToP. lll:ltwillhstatlding the fi:lreeoing,, for any entity that
becam.e aPanmpant of. SQIJmrtory prior to the Implementation Date,.
Signatffll! shal (ii <icmtraauilllly obligate such entttv to m~ply wfflt the ToP
within one-hundred eighty (180) days of the l~h!mentation clllaite, prowded
that sudl Parlidpant is and 1remains a party to the P,H1kiipant-Q.HIN
Ae,eement, iils dlefined in
required ti,· Common Agreement Verskm 1.1,
during 5JLKh period; or (ii) terminate such P,iilll'tjcjpant'.s ability to eng,age in
TEfCAExchal"ll;e upon the earlier,ofthe dateoftemimatiiorl of the aisting
!'iilll'tidpant-QHIN Ae,eement or ooe-111.mdred eighty {180) dilYJ after the
Implementation Date~
n
2. lm:orporalian of ·Ried'tak The Rec:itiillls, set. fofth above we incorporated iirito this Common
Agreement i11 their entirety and shaft be giir11eil. fullfon:::e a1ml effect as if set forth iin the body
of this Cb111mon Agreement.
3.l
Rme,gfthe RCE.,tnd ONC~ OINC was diretted b y C ~ in the 21st Century Cures
Art to,, ""m m'llaboralitlin with the Nath:maf lnstitule of standanls and Technalogy anr:I
other relevant ~des wmim the Department of He:ilfth and Human Se~ for
the ipul"pDse of ensuring full network-to-network exdha,.etlf health infmrmrtioo,
mn'l!'ale publk-pmrate ilind pl.4dic-putili!c partnel'Sihips to build consensus and
develop or support a trusted ,exthil~ frameWork,. indlUdi~ a (ommoo agreement
among health inlofmation ~nationally:'' ONC entered into the C,ootract •
With the RCE to impliement; maintain, and Update the Comrmm Agre:ement.
Under the Gffltract, the IRCE is• responsmle fur matters related to the
development and operation of the eM:Cl!la~e i:lf TI and related acliwtiies.
ONCprmndes overliight of the Ref's wort under tile Cootm:t. Under.the
amtract. ONC has the right to review the RCE's, conduct,. induding Desigmr1tio11,
corrective action, and terminiilltian detmons regarding QHINs, t.llte prOlil)el' eJICelC!Lltioo
m:indiscnmma1iion and cmllict ofiiinteres:t. pai~.s; that demonstf:illte a
commil:ment to tfansparem;, fair, a:m:I nonr:liscriminatmy treatment: by the ICE ct
.or
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Federal Register / Vol. 89, No. 85 / Wednesday, May 1, 2024 / Notices
16:59 Apr 30, 2024
a ,·"·
Federal Register / Vol. 89, No. 85 / Wednesday, May 1, 2024 / Notices
35123
to pi'ml'ide Govemance services for itS De~d Network. tn addition,
SQ1tiltory has the l"esources and mfrastruc:klre to suppait a, reliable and
trusted network. The spedlit:, required meam to demoll!itrate this: are
set ftlnh in an SOP{s,}.
ff, at. an~t tine durme: the term of this Ciommon ,Agreement, Signatof'\I Discovers that
it fai6 to meet the fm'egmng el-ity ,ait!elia or any additional requirements set
farltl. in ·the apptkable SOP(s),, Sil!'litafy Shall immediately noffly the RCE.
4.2
Affin'l'laticn 1111' Applicatloo.. Signatory represents and Wiili!T,ants thilt the infmmation
irl ibi application tor Designation. 'Wil!i at ·the time Clf the applka.tioo !itlbmisml, and
continues to be ,as: ,0f tile CA Effective Date,. Bmrate and complete, :to the best ofits
k.nowledge. Signatory illtfmOM.edges that the RCE relierh.1pan the inft1fl'llatio11 in lits
app~ to evall.uiite whether SilJ'l,iit:my meets the airteria to be DesQ1\iilted and
that vi•Dlati.on of this representatioo and warranty is a material biead1 of this
COmmoo Agreernent. ff the RCE detennines that information in the. application that
was material to the RCEsdedsicm to Desigm1te Signatory is or was, not a<:curaite •or
ccffllflliete, the RCE may terminme Signatory's Des~nation and this common
Agreement>cmd IIVill provide notice ofsudl terminatiM to Signatory.
1
:5. tmmg,e Mlm81t!ffi1erlt
S.1
Chane Ma@ffl'flent framework.. The :Rc:E shail. coardinate all chaqes to the
Comm,on ,Agrreement, the Qlf, and the SOPs in conjunction with OMC. In adcltioo w
the activities described below, OHC shal be awililble in a tons11Jltme role
throughout the change management process to review any ;proposed amendments
ta the COniman Agreement, the ,Qlf,. and tlie so,.s aswefl H the adaptiOn of anv
new SOP and the. repeait 1111' any 9istinl SOP. ·lhe RCE will wm'k with ONC,, the
Governing O>uncil., and the QHIN and Paniic.ipant/S'Llbpaltidpant tauc:u5e5,.il!i ..
outlined below, to cffl'l.sider .ilfflendrnents to the Common Agreement:, tlleQTf, or
the SOPs and the adaption of any new SOP or the repeat of any emtiq SOP...
Pnwided, hoWever, that thf!· attioos described in Sections .5.. 1. tllroogh :S:3 of this
()ammon Agreement by or With respect to the 60Verniq Couridil, ·ttte QtflN cauws,
and the Parti.dpantfS1.1:bpa1niidipant Caucus., as appl:ici!ible; shall not !be required untiil
.tll\e respective bodf .has been established iil\S described in. Section 3 and the
appieable SOP(s). SignatmY adi:nowtedees that it and. the RCE do not hi!re the sole
lepl aumolity to il)l'ee to ma•s kl t!hi.s; Common .Ae:reemen~. the QJf, er t.he
SOP!l. ONC must approve all changes, adiitiCIM, imd deleti:m11s. Tue Common
Agreement m,ust be the same fur all QHINs.
1
:S.l
Amendmg thE! Comrrum e,reement or the QTE The RCE u; tasked, under its
Cootratt with mu::., with 1.1pctating the Common A,greement and Qlf. P\ropo$ed
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35124
Federal Register / Vol. 89, No. 85 / Wednesday, May 1, 2024 / Notices
.amendments 1D the Common Agreement or QTF may originate from multiIple
s:ouR:ies, mduding, illlJt not limited to, ONC, the A.CE, the Gmreming O:runcil~ the
Q'HIN Caucus; w the Partiti,aint/Su!bp1utkipant: eauws. The RCE may COMlJlt with
the Governing: Coum::il, the QHIN Cilw::IJlS, ,or the Palticipa1111;/Subpil!ft1Ciipi'111"1:t Cill.lO.IS
prior t,cuubmitting; the proposed am:enclment(s) t,o ONC for OOMideratiDn. The :ACE
shall mlect all proposed amendments and submit them to ONC, woosnalll
determme wllietherfurthelr action cm a prqiosed amendfnem: is wi11l111"1:t'ed;
s. .2:.:1
11 •0NC:. determ1lnes that a proposed amendment wamnts furthelr
consideration, then the RCE will present the pltlpDSeld ameruhent to the·
Governing Coum:il for its feedback. TIie G ~ C:ooncill will evaluite t!he
p ~ amendmelllt and determine 'Whether it will. seek: feedbiKk: from the
QHIN caucus, the PalticipaMJStlbpairticipimt caucus;, ,or both, as deemed
neceiSilry and apprc:q::riiete. Tiie Governing Q>urn:il will Pfl)'i,ide the RCE with
written f'eedbad;; on.the proposed amendment: in a tiimett, manner, which willl
mude feei.'l:)ad( ftom the QHIN and Pan:idpant/Subp;nticipant: Caoouses as
applicable and appropriate.
5.:2.2
The RCE .shall amsudt: Wiith ONC about the Gm.ierriing Cotnu:il feedbac:k. ONC:::
shall, after ,i::onsidering the feel:lbiild:, •determine: whether the proposed
amendment: shoold pr,m:eed ilfter making ·ilinY Changes to the. amendment. If
ONt decides to proceed ·'Mith the amendment:. it win advance the proposed
amendlmenuo the QtHN Cauc:Ll!i kif illPfJl,flQ'iill by a written 'll'Ole. An
amendmeritwiilll beapprmed.ifat least two-thirds fl/3) of'ttie•!mte!ii·castlby
the QHIN tai.ac:IJlS. members 'Within the timefl'ame e.srablisbed by ONC:::Jor the
voting period arem t.ivl:lf·ofttie proposed amendment.. The requirement to
consult with the Governing. Cm.mdill in this provision .shafll be· .satisfied bV
ONC's approval ofthe prQposed amendment if, iltt:hetime of such appmwl,
the Governing Coulldl and t!he QHIN. Cilurus have not yet been established.
5.:2.3
The time period for ONC to decide Whether to proceed. or not Wiitlh pr,l'Jiposed
amendmel'lt 1D the· Common Agreement pursuant to :5ecl:ikln s.2.2 albCJ!ll'e ••
mall iimanty lbe three (3) months .after ONC receives from the· RCE :f'eedbadc
fmm the Govet1n:q Collf!Ciil pursuant to Secticm 5.2.:2 above; provided,
however, that ONC: may, i.n its discretion, extend this time for•ill'I unlimited
,number of ai:ld.itmi:'lal three- (3-l month time permcls.
5..2.4 The time period for ONC to decide wl'letlher to proceed or not witl'I a
propo:sed amendment to the Qlf pursuant to Section 5..2.2 abave shaU
lnitiaUy ille three (3) months after ONC receives from the RCE feedbac:k from
the Governing toulldl pursuamtoSeaion 52.2 abo\l'e; ~da.1. hi:lwever,
that ONC may~ miiU discretion, extend this time fur one (11 additional three•
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5.2c5
35125
ff .illfl amendment to the• Common Agreement ,m-QTF i.s approved as
desc:riibed ab::Ne~ the amem:lmemshall.become effe:tive on·d'te effel::tiYe
dillte idlentified by ONC as part of the ,ilfl'lendment process and shall be
binding on Signatory wil:hmrt any further action by Signatory or the RO:. 11'
Si(fi'lmm:y is not wiling or able to comply with the amemlment; then
s.,at,m:y 5hiilll, Wiltiin fifteen {15:) bU5il'IBS days of being notified ,by the RC:E
thi1: the amendment !hiilS been awraiied, provide the RCE written not'io? ,of
termihiiitian of thi.s common Agreement effectiYE: no later tmH1 .the
expinition ofttmy t:3lll days from approval ar the amen.dment
m
:S.2.6 Notwith!itam:llill'lg the fo~ing, if the RCE determines that an 11nu!ndment
the Cnmmon Ae,eement or Qlf is required. iii order for.'lhe RCE to remain in
compliance wilti Appik:alble Lin11~ the RC: is not required to provide QH!Ns
with 11'1 oppcntuni1:y .to vote on die amendment. However~ the ACE .shilfl 51:iiil
be required. mproYide sixty (60) days' ao;mce written ootke of the
amendment ,and legal .;milfysi:S of the need to use this expedited process,
Ullle55 the IRCE 'lllfOuild be materially harmed by being out of CDmpliance wil:.h
Applicable I.aw ifit provided the sixty (00} days' 'M'itten nGtice, in whidl case
it 'Ii.Ill provide as mu::h notice as practii:abie under the circumstances. Amt
such amendment tai this Cnmmon ~ e n t orthe QJF :Sfliall be subject to
ONt review aml modification prior to the ICE prow:l~g advanre" written
notk:e of the amendment. to Signatory. Omy those amendments that are
appmve.d W ONC Wil be enacted.
:5.J
Amending. Adtlpti!Pf!, or Repealing an SOP~. The RC:E is tasked, under its Coot:t.ict
with ONC, with developing ,an im1:iii11 set at SOPnhat were amsidered ,ildopted when
initialy made pubtidy available prier to the.imtial QHIN application period (i.ec, prior
to a,,~·sigr\iing d'te Common Agreement). The amendment process set forth
lbeloW shall ,alsO al'P!l' to amending: ·l'he i11itiat :set Of SOPs thrctQl:h adoptiirlg .m,e or
.mare: new soPs. repealing an SOP in its entiretr, ,or ameiiding one mthe inltiiilll SOPs.
:5.:3.1. Proposed amendments to.the SOPs may originate from muh:Q>le sourt:es
induding, but not limited to, ONC, the RCI; the GO\/eming Cooncil~ l'he QHIN
cauc.us, ,orthe Parricipant/Sub!palticipant•taucus. TI'l:e RCE may consl.lltwtth
the Governing Coum:il., the QHIN taUOJS, or tl'le Pilrtitipant/Subparticipant
Caucus priDr to submitting the pmpased arnei'ldment.(s) to ONCfor
consideration. The RCE shalt coHett .ilfl proposed amendments ,and .submit
them to ONC, \\l'ho shaH determine whether further action on a proposed
amendment is wammtec[
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35126
Federal Register / Vol. 89, No. 85 / Wednesday, May 1, 2024 / Notices
:5..3.2
If ONC detem:!ines that a proposed amendment 'Wilmnu !lit.lrthet
oonsideratioo, then the RtE. will pr,esent the proposed amendment to the
Governing Coum:it for its feedbilldt .• The G ~ Cnund1 will evaluate the
pmposed amendment Ind determine •whether it will, .seet feet:lbaidt from the
QHIN Qn11cus, the Partidpan~ubpartit•illnt caucus,. ar both, as deemed
n ~ and appr,opriate. The Gavetning Coondi Wi!.lewluate proposed
amendmenltS in a timely manner and provide the Ref w.ith written feedbadt
on the prqpmed amendment
The ACE shall COOSUlt mth ONC abol.lt ·the Governing Council feedbadt .. ONC
shill!, 11fter Cffl'l!lidering the feedback, determine whether the propmed
amendment ihoold pnxeed ilfter making ii111f d1anges to the amendment. If
ONC .decides• to proc.eed wiitih the ainend~, it wil advance the proposed
11mendment to, the ,QffliN Cauc:m and 'the Participani:jSubpartidpant Caucus
for 11pproval by a wntten IK:lte: An amendment Wii be appl'O'fed if at least
~ (l/3) of the IK:lte5 cast: by the QHIN CiM:IJS and. at lefil two-thirds
(2/lJ of the· \l'Oh5 cast. by the· Partkipant;f,Subparticipant caucus ~ the
timeflaine established by ONt mr the wting: period are in ·t.lrimr of the
pl'OpDSled amendment. The requremem: to, ,amsult with the Govef"l"liinl
council in this pRJ!irision shall be satisfied by ONC~.s app!'Ciral of the pr,opmed
amendmenl: if, at the time or such approval, the Q.HIN Caucus and the
P~ubpaniidpant CilUCWi have n01: yet been·est:ablisinec:t
The time permd 'for ONC to dedde 'IM"lether to proceed or nm ·wilfl a
pmpm;ed amendment to an soe pursuiil!nt to .Section :5:3.3 al:ro\le shall
!initially ibe three (3) rmooths after O'NC receives tram the ii.CE reedbadc tram
the Governing to1mdl; pmwded, hm.vever~ that: (a) ONC may, in its
discretion, •eictend thiis time for one (11 additional three~ (3-) month time
periml; and (b) if ONC, 1in addition, detennmes in its reasooabte, dis.aetioo
that ·ttie aff'lll2ndmem affects or maiy tie cootrary to ,;m ONC poficy ,or .;mo1.tier
policy of. the Department of. Heafth and! H11mM SeNm or any A:pptiitabfe
la'W', ONC may extend this time for an unlimited number of additiooal. tihree(S-.) month time periods.
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Notwithstanding the requirement !for a l'artiidp;mt/Subparticipanl: vote set
fm1h in Section 5,3.3,. if the proposed amendment Willi not have .a milterill
impact mi ·.any Partidpa111ts « SUbparl:kipants, oNC may advam:e ·the
proposed amendment to the QHIN caucus only, 'Whereby the amendment
Will be illllfJftlltred ifatlieantwa-thiirds (2/3)iOfthe '\!llltes can by the QHiN
Oliutus Wiitml'I the timeframe established by ·ONC for the '!ffltlng p.eriod are in
mar of.the proposed amendment~ The requirement to 00111s111t. with the
QHIN Caucus in this pn.nlisioo sllaffl be :saliisfied by OP{~s aPfJll"QWI Qf:the
Federal Register / Vol. 89, No. 85 / Wednesday, May 1, 2024 / Notices
35127
pmpased ameru::fment if, at the time al' such appnivat, die QHIN CiiiiLICUS has
1nat vert: been e~bUslhd. The IRCE will detenmne an eft'ective date for !the
appmve.d amendment Slllbjed tD approval of ONC.
:S.3Ji Notwitl'Qandiing the foRIIOillll. if 1lhe RCE determines that an amendment to
an SOP rs required in on:ler for the RCE w remain in compliance 'Wiith
,Applitilble law, the RCE is: oot required tD provide the. QtflN Qi111c:us.or the
'P,airti:dpant/Subpankip:ant Ciil:Ucus with an oppoltUl"ity to wte cm the
amendm,ent H ~ . the: IRCE maJII still be required r:o prowre sill\! (60)
days' advance written notice oftbe amendment and the legal analysis of the
1nee1:no wie this exper:lite.d pmcess; 1.1nless ·the• ACE would be materially
lh.l!ffled by being out of mmpiliiilnte wnh Applicable I.aw if It pnwided the
sixty (60) days" written notitee,. 1n which ca.se the: :RCE wlilf provide as: much
natice as pratticilll:de Ynder the cira.rmstances. AnJ sud'i a:men.dment to an
SOP .shaJil be .lllJl:ljett to ONC review and modifation prim· to enactment.
Only thme. amendments that are approved by ONC will be enacted.
5.4
Vang Methcxt For Ptlrposes Df tne votirlg process set forth m ttis :Sectton s~ the
phrase "writt.en Wh!"' ilooudes. any process by Ml'hktl there 1rs I voting record, which
.may indUde: voting by etettmmc means.
iii, Cooperation and Non-Discrimination.
6L1
9'.!qpe!Jtip111, Sil,natoiy understands md acknowledges that oomem111s attivities
with respect tot.his. Common Agreement wifl Hk.elty iirwohre other Q.-iflNs and theilr
respectille Patti~ and SUbpartidpanu. as well :as: e m ~ ,agents, third-'
party· mntrattoR, vendor.s, or consulbmts of each of them. .Signatmy shaH
reasonably cooperate JtVi,th the 1ACE, ONC, 'Dtl'te1r QfflNs, am:I their respective
PartidpmtS and SUbpartidpants in all maltlters related to TEfCA Exchange.
.Requiin!miems for reaSO!mlble moperadon are set lbrth in an SOP. Thie ca.sts of
cooperation to Signatoiy shall be bonrte by.Signatory and shall ootbe charged to the
RC'E ,or .other QHINs. Nothiing in this secticm IU shall modify or repliiCe' •ttte lEFCA.
Sewtly lhcident notification obligiltmrlS under Sed:iori U.3 iH'ld, if applicable, the
!AS, lncidel"lt notification ol:llliigam under •Sediml 10.5.2 Df tlis Common
.Agreement.
61.
Nbn-Dim'iminiitm
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Pmtlib!tion &@inst ~ - Neither Signatory nor the A.CE .sl'lilll prohibit
or attempt to rm,hibit anv QfHN,. fiartidpant, or .Subparticip1mtfrom joining,
e!llclilan.ging. with, mmiucti'lll other transactiims with, ,or supporting any other
networks or eR:hiange frameworks that use services othi'!:r tl\la,t'p the
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35128
Federal Register / Vol. 89, No. 85 / Wednesday, May 1, 2024 / Notices
Signatmy's Desi,enated Networit Services~ amtUll1'1eritly wittl the QHIN's,.
?lftiici~s, or .$ubpllmcipant's participation in TEfCA firmnee~
6.2.. 2• :No pisgjmmtory limits on &manm; cf TL Signatt'lfl/ shall ll'IOt: engage in.
TEFCA 'Exchaqe, refrain from engaging in 11:FCA fxdtange, or limit TEFCA
:Exm111nee wit.h any •od"rer QHINI, Panidpam, Subpartkipant,. or fndividua¼,. in a.
Discriminatory Miner. NotwitNllilnding the forepine;, i1f Sqi;Dilltcry refrains
from engaging inTEFCA Exchange. ortimits intemperabilitv l\l!ith any other
QHIN, :P.artiapant, or SubparticQiiilnt under the following dn:.umstances,
Signat~s actions or inactiims shall not be deemed dil'SClimiDilltt'lfl/: ![i)
Sigmltmy's Cormectivity Semces require load !biil.anclrn1 of netwon:: traffic or
:similar ,actwities pnwided such ,111Ctivities1 are iimplemented in a ,amsistenlt and
mm-dismminat:my manner for :a perm of time na, longer tha11 necessary m
address the network traffic iHue; (ii) Sigriatory has :a reasooilble :and good~
faith belief that the ether QHIN, Participant, m :!ilubparticipant hes ll'IOt:.
sati.sfiedl .or WIii not be able to satisfy the applicable terms here°' l;indudiq
mmplmnce with Applicatl&elaw) in any materiial respect; or (iiiil Signator(.s
a.ctibns or' inactions: are. consistent with or permitted 1:1¥an applicable SOP.
one QHIN suspending iJlts e:miange iK:liMties with .am:ittter QHIN, Panidpant,
or SubparticQliilnt in accordance~ Section.17.4.2. shill not be deemed
disaiminat,ary.
6.2.3
Updates toConnecitiviity Services. 11'11 revising and up:lating its Connerti:!ril.y
:Serviices from time. to time, Signatory will use mmmermrtv l"eillsonable
effi0rlts. to do .so in aoror,dance ·wwtlh generally ilCtiepted industrf prm:tites and
to implement any changes in a r11:m-discliminatmy mill'l'll!:'r:; prOllided,,
lhOitll'e'lier, this proviSion shall not· apply to.limit modirfiamons or updates to
the extent that such revisu:ms or updates are required by Applica!b!je law or
impleme111ted to respm,d promptly to newly discovered priwty or security
threats.
6.:2..4 Notice of Updates to COnnediyit,: Services. Signatof'II' shall iimplement a
reporting prO'lltXOI to provide reamnable prior ·wrmen natice d all
modificatioos or updates of its Cormeaiyjq! Sefll!iices to all ather QHfNs if
SUCh revisions or updates are ,spectedm :i3!Ch!ersely ilffett lEftA &thange
between QHINs or reque dlang,es in the Connectivil.y:Services, ct al'l'!I other
QHIN, reg,ardles;s whe1her they. are neceisary due to Applicable Law or nell'i!I\I
dis:covered pnv,lq' ,ar .security threats,
6.3
Non-!1ntelferem:e. Silflatory shall oot preiirent a Pamciparit or Subparticipant from
chiil!IIW'fll .ttle QHtN thro11gh.whk:h ·the Pamdpam. or Su~articipant engages iin
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35129
TEFCA. mhaqe. Notwit:111standing the fi:Jr,$ing, ·this wbseaio11 does not predUde
SifJnatarv from iinducling and enfi:Jr~ reiasmBble ·1term .lfflllllts in its c.ootracts with·
i:ts: Participants related to aPartk:ip;mfs use of Signa.ltmy"s Desiignated Ne'two!i::
Sentiices;.
"1" Confllilentidity an.d Aa.:ounbbilitJ.
U.
•Confidential ilriformatian. Signatory and RC.E each qre,e to ~· and disdme all
COnfidentii.11 Ilriformatmn received pursuant to ··\IJms Common A.gre:ement only as
autoonzed in tints common Agreement and any ·•Jllicable SOP(s} and .solely for ·the
p1.1rpo51e5 Of perfo~g:lts obl•tioos: under tlisCommoo .Ag;re:el1'l:elrlt or the p ~
ei«hanee of information under the CMnmon Agreement and for no other purposes
Each Party mil!Y act as a ti Olmoser and a C:I Recipient, fflll:oo:ingjl¥. A Cl Recipient
may. disdme the Ccinfidentiai !information it re1:ei\ies only to Its Worldbn:e Members
who require: suth knowledge and use mthe ordinary course :a:nd KIJ,l)e of their
employment or retention and are Dtlli~ to protect ·ttie amfidlentiality Of the Cl
llisdmer's 0::mfidential lnfnrmi!ltion. !in a mal"ll'le!f' si~l>stimtiidly e~ent to the
terms required herein for the treatment ,of COnfide!ntiill lnfimmation. ff a a
Recipient must disdme a Cl Di:sdoser's Cricllenml tnformation under operatkm of
law., the Cl .Recipient may do so pnmded that,. to the extent permitted lb\' .Applcabie
law, tile Ct Reciipient gives the Cl Disdmer reamnable nmice m aHow• the a
Disdoser to abject to such rediisdosure,. and such redisciml.lre 1is made to the
minimum extent necessary to comply with Applicabl!e law.
1;2
•DiS'dm!f.ll'e of Confideptiijt frifmmatkm. .Nolhing herein shiU be inteq:1111!:ted to•
prohibit the llCE from disdming: any Confidential llnfmmatial'I to ONC. Sjgl'latDry
adl:nowledges tlha.t ONC, .as a federal go,;emment agency, is subjett to the Fre:e.dom
of lnmmiatioo Att.. Arrt disclo:511.1re of Slenatory"s O:mfidential. 1rfim:mi!ltion to ONC or
any ONC mmractmc will be· s1.1l::rjec.it t•D Appicable I.aw, as wefl u the tiimitdloimi,
pmcedures, and otlher rele\tant prm,isions o.f' any applicable SO~ls).
a
1..3
ONC"s snd the RCE's Appro,actl When Requestim! Confidential lnfmmatim. As
.matter of general policy,. ONC •Mfl request Olllly the li~d set of COnfidel'ltial
llnformariari that ONC believes is necessary to inform the .spedfi:c facts lffld
mumstances of a matter. The ROE wiiH request ,cmlly the lil'mtecl set of tonfidential
1/nformallioo that the RCE beliel.les is necemry to infmm the 51pecffi:c fatt!i :and
ciiralmstanc:es of a matter,.
7~4
9,HIN Acoauntal:!iili;ty.
:7-4.1 Statemem:.of,General Pnntjple. lo the ,e1:tent mt pmhtited by Applicable
law, .Signiltl'.HY shall be re:span.siblle for its am and omissiOns.• and the att!i or
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35130
Federal Register / Vol. 89, No. 85 / Wednesday, May 1, 2024 / Notices
omissions of itS Participants and their SU'bpartidlJiillntS, but nCIII: :l'i:llr the ,ilCtS or
omissions of iilflll' Dither O.HINs Cir theiilr ,Pankipilll'ltS ,or :Subpaniidpimts..For
the. iNOidam:e of doubt. a Signatmy that is also II gwemmenhll :qency m
mstnmient:ality sbd n.ot: lbe iidlle to ·the e:nent that the Appficable lllw
that governs: Sigmitmy does rmt e1111Premv wawe Sipatol"l(s savefeip
immunity. Natwith!it:amlingany provision mtlhis Commcn ~ e m to the
contrary, Sienatorv shall not be liable for any act: or amisu:m iif a. •cause. of
att:im
such. an or ammoo is otherwise pmihibited by Appllcabil.e law. .
This Sectioo 7..4.. 1 wll not liJe construed as oo&l-'hilllimless or
mr
a
memnifimmn Pf'O'!Jision.
7.4.2
Harm to RCE. SUb,iett to Semoos 1 ..41 and 1.6 of this Common Alreement
that emw:te certain types of damages or !Limit iCl\l'erali damages. Sig:naitffl'\!
nll lile 1responsible for ham suffered by the lilCE to the extent thiiltthe harm
was caused by Signiiltmys bream of this Cammon Agreement, the QlF~ or
iH'lyapplkaible SOP.
1 ..4.3
Hiilrm to 0the1rmUNs. &.lbject to Section 1.6 of this Common ~ e n t ,
which excludes certain types; of damages Cir limits M,rall damag,es:,. Sipattiry·
shall be respoosible for harm suffered by another QHIN. to the l!'xtem: that
the hiilfffl was caused by.Signata,v's breid1 of this Common Agree.ment;'the
QTf, •c:w any apphcable SOP.
75
ICE Aa::m.mtabil!!Y:. 5ilnatory will. nm hold the RCE., or anyone attirtg on its htha.f,
•including but not limited to members ct the Governing Council, Transitional Council,
Oitucuses, Cybase:cumy Cctmdl, any Advi!IQll'Y Group, .any wort group. or any
sum:ommittee, itS mni:ractDrSi, employees, or agents liable for any damages, lmses,,
liiabilmes, ar injuries arising ·ifrom or re.11\ated to thiS Common A,ereement, extept ta
the exl:ent: that s:udh damqes, lms~ liabilities, or injuries are the direct result of
the RCE•s breach of thiS Common .Agreement. This •s«tii:cm 7.5 shall not be
construed as a hold-harmless or ifldefflnill'iciiltiiion ~mw:sioo.
7.6
UMITAOON ON UA!BJIJIJY. 'NOlWITHS:TANDING AJNYTIURG IN lHIS COMMON
AGREEMENT TO 1HE OONTRARY, SN NO EVENUKIW. BtHO THE iRCE".S OR.
SIGNA:JOR'lfS TOt:Al UABIUJY TO EACH OTHER .AND All OTHER QHINS 11.Rffl!NG
FROM1 OR 118.AUNG lO THIS COMMON AGREEMENT EXCEED AMOUNTS EQUAL JO
1WO M1WON OOUARS ($2,000.000) PER INCIDf.NJAfID FIVE MILLION OOUARS
{$5.0IXl,fflmj AGGRE6ATf P!ER .ANNUM OR SUCH OTHER. A.MOUNTS AS STATI:D IN .A
THfN..:IH-ER=ECJ SOP, IN ORDER TO AILlOW FOR THE l'fRIDDK: IIDJUSTMEflT OF
"tHIS: UAIILRY UMITOVER TIME WtlHOOTfflE NEJEDTO AMEND THIS COMMON
AGREEMENT, THIS .A.ND A/NY SUCH ADJUS11:0 uMrrATION ON lJABILIJY SHAil.
Ai>PILY REGARID!IJES:S Of WHEIHER A. Cl.AIM FOO ANY SUCf!I UABIIUlY OR DAMAGES
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35131
!IS PREMIISED UPON BiREAOI OF OONIRACT, BREACH OF WARRAN'ff, NE6UGENCE;
STR.ICT UAJ&UTY, OR AN.'lf ontEfffflEORIES OF UAlllfJY,. EVSUF SUCH PAftn' HM
BEEN AiPPRISED Of THE POSSIBl.fJY OR UIEUHOOO OF SUCH DAMA68
OCCiURRING. IF SIGNATORY IS A GOVERNMENT .AGEJNC't OR A GOYERWMENI
ilNSTIIUMff{fAUTY UNDER FEOEAAUlAW, STAlH.AW, LOCAU.A,W, OR fflllW.
lAW ARD If !IS P!ltOHIBltED FROM UMmNG m RECOVERY OF DAMAGES FROM .A
THIRD PARTY UIIIDER A.l'PUCA!Lf lAW,.THEM THIS SECTION 1.ti SHAU. NOT APPl'lf
TO ERHER SIGNATORY OR Ttlf RCE .. iNOTHING IN THIS SECTION ];6 OF Tl-IS,
COMMON AGRfEMfNl:SiHAll EIE CONSJRUID TO CREATE UA!lmY FOR A
60VfRNM1ENTAl AGENCY OR WS:lR.UMfNTAlfJY OR OfflERW1SE WAJ\fE
SOV;EREJGM IMM!Uffffi'.
8.1..
Access to and Use of the :aoE Direct:my Senrice. DI.Hing the term Of this cmnmon
Agreement and provided that .Siel"llilt:my is not suspended,; line RCE shi!II provide
S.-atory with access to the ICE Directory Servic:e. The timeframes and
requirements for aa:en ·to, publishing llira::tory Entries in., and. use of tfo!!, RCE
Directory :Senke are .set mrt in ·ttte QJF 1111:1 ·:the appkablle: SOPls:).
1!1"2.
Utililation of the l!tCE Directory Sen.iite. The RCE Dill'ec:tory Senrice and Direct'.Dl'J
.Entries ,cootaiined ther•ein shall be used by Siigl'lilt:my SOieiy as nete&:111' to create
arid maintain operational m111nec1:Wity under the C:llmmon Agreement to enable
TEfCA. EXC:hallfl:e. Signatory .shall not use or dlisc:km! Direttoify 'Entries t!'ll:CeJlt to ib
Workforce Members, to line Workforce Members ofiiits: Panidpanlt'S.•or
:subpiilltidpants, oru, the Wor'ld,c:irce Members of iheatth intormaoon technology
vendors who are eng.agec:11 in assisting Signilrtory, tllle: Partitt>illllt or Sullpalticipant
with engiqing in TEFCA &dmnge. further,. Sigriatmy .s.half r,ot use anmher QHIN's
;Directmy Entries or information derived 1ihe!1el'irom ·far mariceting or ill'IJ form of.
pmmatmn Of its own prodlJICtS and seirvices., lilflless IJll:iherW&e penni1tted pursuanuo
an SOP. In rm event shall Signatmy use or di:sdme the il®l1l'llatmn contained in the
.ACE Direttary Seniite iirl a
that sho1dd .11:re reasonably expected t o ~ a
detriment.i!ll .effect ,on ONC; the RCE, other QHINs ar their Pi!lrtil:lipants or
Subpillticipants, or any other individual or org:amzatioo. •for the i'f\!Oidance of doubt,
Dil'Ktory Entries are Confidential h11formatim ofthe Disdmer except to the extent
mc'h inl'ormation. meets ane of the· e'll:CeJltians to the defil"llilm:ln Of CooMential
linfi:11'1ftalioo. Nothing here.in shall be interpreted. to prohibit a QHmN from publicly
disdosing the identity ot its Pani~piliflts or Sul:lpanidpants.
manner
8.3.
QHtN .QirettlllfY fntties; Signatory mUSJt hwe at least one Node ,isted in the JICf
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Direc::tmy Serwce. Signatory tS: responsible fOt entering mts Patticipantaird
Std:lpiftiicipant Nodes in the RCE Directory service. and maintaimng t'11e aoot.1rm:y of
35132
Federal Register / Vol. 89, No. 85 / Wednesday, May 1, 2024 / Notices
-~~•~==
•in mnnedionwllhSienamrvhiisapiredorheentermmated.. •
•
a:.~ .• Frainewark~rit~nf
&llB~ll~£t~~~
···!~~·.··.··~..:~~~~Pa~~~···
iaPj::•:iir~~
~·.··.·~~~ies;
"· iaEE.=a~~~•od
,applicatife..
=~•==a=-·~•
• ~~ if appitable;
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35133
aP:Pkal:lle SOP(s). such Response m111sti1ndude all lequilrel:I l'nfmmation.
Nll:ltWithstaming the foregoing, Siginatory may withblllll::11. SOfM! or aH of the Required
lrriir:mmttim ·to the: extent necessary to co~ly With Applicable lilW·.
9.5
Special .Legal Requirements. tf and tc Ole ei<tent Applicable law requires that an
fndividuall either <lament to,, apprm.re, or provide an iilllthorimtion far the Use or
Qisd!Osure of that 'lndi'll'iidual's irilformat:mn tc;) Si,ln1tmv, such as a more stringent
federal a- State law relatq to sensitri,ie health infmm1tian, then Signatory mat[
refrain from ·the Use or Dis.doS11Jre of such infomlation in amnection. with ·tms
.Common Agreement unless such lndiYiduaf's mnsem:, approval, or authoriizinioo. has
been obl:ilined coosilstent wilt! the requirements ofApplicable Law iillT1d Section U. of
this commoo .Agreement mcwding 'Without timimicn communicated pursuant to
the aa:ess consent policylies) l:lemibed in ·the: Qlf or appticallhfSOP(s).. ~ies of
such consent, apprmal, or authorization shill be maintained am::ltransmi:tte:I
pursuant to the proce.z desaibed in the Qlf by whichever party is rnequired to
obtain it under Applicable I.aw, and Signatory may make sudl copies of the <OOsmt,.
apipmval, .:or amhoriMtion a'l!!illiilable elertn:>niciilllly to any QHIN, Partidpant, or
Subpartidpiifflt in aci:omarice with the Qlf and :to the eclient permittall bV
Applicable law. Signatory shill! mainltiiin !Mitten po'lides and procedures to aHaw an
hn!IMd!Jil! to revoke sum mttsent, appmwl,. ,or .authcim:ation on a prospective bai.&
:If Sligr'Btory is an :!AS Provider, the foregoq shall not be interpreted to modify,
replil!Ce,. or diminish. the requirements set forth in Setl:ioo 10 of this Coml'rlllll1
Agreement ,and ·il!RV ,11Pplicable SOP(sl for obl:ilining an lndiliiduafs expre!iS written
CORRl'lt.
11:u
Jndmdui'I Attess Sel'\liices {IASI Ofieringfst- SienillttlY may etett to be. an !AS,
Pr:miid·er ~ offering IAS to any fm:lim~ilil in aa:ordanoe with the lll!!Quirements of
this Set:;:tion lO and in arcOAiance with all other: provi.sions of this Ccmmon
Agreement Nothing in this Seclion 10 .stii'II modify, terminate, or in any Wi/f affect:
lndividuill'!s nght Of aia:ess 1.1.ndl!r the HtPAA Privacy llllle at 45 CfR § 164.524 Wiittl
respect to any QHIN, Partiqpmt~ ,or S:ubpartk~ant that its a Cnvered Entity or ai
B1.1siness Ass•DCiite. Nothing mthis: Secttcn .roof this Common Ae)reement shall be
construed as modi~g or tilting precedence over any Pffl\l'islion mdffied in 45 Cfl
Part 111. An &AS Providersllail not .pmhibi:tor attempt to proihit>it any tmiwduai.
Using the: IAS of .any other IAS '~ovil:ler or fi'om joimng, exctiariglng wi'd1, amd~
illther tr.insil!Ctions with any other networts or exchilngie frameworf<s, ming services
an
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26
35134
Federal Register / Vol. 89, No. 85 / Wednesday, May 1, 2024 / Notices
ms
other man the.
Providers• Designated Nenvort Savic.es, cmou1rent1:y with the
QHIN's, Pamdpmt's, or SUbpartidpaitt's panicipatio11iin TffCA. ~
10.2
:fndMdUail consent. 11'1liis Settioin 102 shall apply to s.gnatory if sw-atal'V is: an IAS
Prowder. the lm:ividnal requesting IAS shall be rre:spo11sible for to111plelting the IAS
Consent. The IASCoosem:shall indude,.ata mtnimum:(i)coosienttowethe
llndillidw!JI Attess Senrice,. (iJ the fndividual's adcnowledg,em,ent and ,qreement to
the ·FAS Prmiider's :Privilcy and Secuifl:V Notice; ,ilmf Uii) a desc;ptrmi :at the
llndMd!Jal's rights to aPCe.ss, delete, md span sum ~ndiiriduilll's lndil!idl.ladly
lidentffiable: lnfmmati\tm. An IAS Prnvider may implement secure elettrmic meiitirt5
(e.g., secure e-mai. secure web portall)by which al"I tndNii:dual may submit ·the: IAS
CQnsent. An IAS Ptovider .shal toHect the IAS C:Onse:111: prior to the lndividua:l'!s first
use of the b\S ,illnd prior to a!"IV subsequent use· if ·there is any material c:hiilnge in the
applia~e IAS O:mseni:. indudioo; the wersioo m' the· Privacy and securky Notice
referena!d therein. Nothing mthe IAS Corisent may contradict or be 1noo11sistent
with any appficable· flln::l'IIISion of this Common Agreement or the SOP(s). If the IAS
Prowder iis ill •Covered 1Enttty and has a Notlice m' Pmracy Practices.that meells.the
requirements of 45 tfR § 164..520, .the IAS P'mlllder is. oot: required! to have a Pnvaicy
and Security 1Notiice that meets the requirement5 d the appiical:ille SOP. Nothiing in
Section 10 reduces a 0:llil'ered Entitys obl:iiptions under the HIPAA Rules:
lo.3
,lntentionaHy Omttted.
Ut4
~ntentignally Omitted.
105
Additillnal SeCUll'.ity :Requirements for IAS Providers. 11'1liis Section 10.5, shall apply to
S•atm:y if Sigmltory is a11 IAS Ptovider.
.10..5..1 Stppe. IJ/f Seantty Requirements. An IAS ~ must meet the· applicable
seaJrity requirentenlt!i set forth i11 SieclilDn. 12. _. al lndi'll'il:llllally 'ldentiftal:ille.
lnfirmnatioo it maintains ,11un IAS Provider, repRl!eSS d vrmettier suth
mlurmation is ll.
•10.5.2 •Wl Incident Notice Jo Affeped lrtdiyiduals. If an. lAS Pirroviider reasonably
believe.s that an lm:liwduillll has been affietted by a11 IAS Incident, it must
pmwde suclh l1ndividuill wiith notification without: UMeamnabte delay and in
no case later d'liln sildy (60)da¥5 folk:lwq D~l'V d the !AS Incident. The
nctificatioo required. linder this Sec.tiion UJ.5.2. must be wlitten in plai11!1 •
language anti :shall mdlltle~to the ment·possible, tJhe im'ormation set t"otth
iin tJhe applicable SOP,(5).. Ta ti'le e:ittelllt: Signatory !iS a1read\l' required by
Jliippiicatde Law to notify an lru:lividual ,of an incident that.·would .-Im be an
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35135
IAS, lm:ident, this Sec.tion 105.2 does not require di:ipli~e notilitation ltO
that lnr:livicluat
lCUii
Survival fbr I.AS PtmrideB. this Seaicnt Ul6 shall ·il!Ppi\l' ltO ~ · if Signatory i!S an
fAS Provider. As between Sigmrtm,r as an fAS ?rovider and an lndividual,.1he !AS
Provtder'.s obligations in the IAS tomem;. indUdi!"II me tAS ~ s requirement to
co~y with me Privacy amlSec.urity NotKe and p!"O\!ide Individuals with nghts, shaUI
surviVe for so II.orig as the 1AS: 1P,owdermai1111:ains wth Individual's lndiviidually
.ldentffiable I n ~.. If SieniitOll' was an !AS Pn:>llider,. ·the requirements: ,crf
Section 10.5 shall survive termination of this Common Agreement for so long as··.
S•e:natorv mamti!ins, lndilm:hmly ildenltimlble lnl'mmation acquired. during the term of
t!his Ccmm.m Agreement as an IIAS ,Provider regardless crf whelttier such ihfmmation
iisorwastt
11.Privacy.
U.1
Cgmpfige with the HIPAA Privag Rule. I f ~ i!S a NH'E (!but not. to ·the e:inent
t!hat it i.s acting as an entity entitled to make a Glll'lletnment Eleneftl:s Determmation
:under Applicable Law, a Public Health Authority, or a. Ga'1/elfflment Hea'lt!h Ciift <ity
onny ottierl::ype of entity exempted f1rom compliance 'Mt!h .thits.Secti01rU.l iin an
appkable SOP), then it shall c1>mpty with t h e ~ of the HliPM Privacy Rolle
listed. below with res pea: to all! lrdwdualy ldentiliiable mmrmailiDl'I as iif such
iil'lfolrmation is Pmtetted Health lnfmmiiltil:m and Signalt:OrJ ii a ONered Entity.
U.1..1 From 45 Cf:R f 164.5'02. General; Rules:
•
Subsertk:m fa)(lJ- Dealing witfl permitted Uses and. Disclm1.1res, but
omy to die e.uent Signatory is raUlltloriR!d te engage, in the ac:rivities
described: in this :sublemon of dllte HIPM Privacy Rule for tile
lllpplicrallle XP,
•
•
Subsection {a)(l}(il- Reqµiring Dnd.osures t!!J: lndwtdua'ls
•
Subsection (a)(5) - Dealing wi'lh prohibited Uses and Disclosures
•
Slubsectkln (bJ - lleaffing with t!he minimum
nec:essarv standam
•
Subsection {cJ-Dealin1rwi'lh agreed-upon IIMtrittions
•
S.Wsecticm (cQ- lleatiine: with deidentibtion and re-iderlfflication of
iiffi:mnatii'on
•
S'Ubsecttm (e}- Deaiq with &umess As:sooiate. tontracts
•
:subsection {f)- Dealing with deceased persom' inmrmation
•
~ n 11)-Dealing with personal representatnres
•
Subsection l:hl- Dealng with confidential communications,
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35136
Federal Register / Vol. 89, No. 85 / Wednesday, May 1, 2024 / Notices
•
Subsection {if) - Dealing 'with U:SieS and DisdO.SlLl!l!!S oonsis,tent: wil:11
notice
•
Subsection m- DeaHng Widl Qisd05ures by Wll'li~el:ih:rwers
U.l.2 4:5 CfR § 164.SOOet OQ!ill}izati:lnal .9egyreroents.
U.L3 45 CfR §, 164.5081, Authorization Reqyire1t. il\lotvm:hs:tanding tl1e forepmg,
the proimiom ct:Seaitins 1tl2 shaH ,io.antirm and d1is seman U.1.3 shaU not
1
apply wiffl respa:t to an IA:S Pn:wider tbilt is a NHE..
ll.1.4 45 CfR § 164.510, Uses and D§slosures: R;tguiriffl!! OpoortunfW to Aftee or
Obiect. Notwitlhstiindin.g the fo:regatng, an !AS Provider that is ill NHE bUt is
not a Health Cilire Pirowder' shiilll not hilYe. the•~ to make the pemiim.e
iOisdosures described in§ 164..510l[a)(3)- ,&nereency dmJmstances;.
pro'1ded, however~ that illll IAS Pl'Ollider is l'IQt prohlbitecl from lffilking sum ii
Disdosure if the ndMdual hils mnsented ·to the Oisdos111re pursuant to
1
Section lll af tlhis Common Agreement.
11.1.5 4:5 CfR § 164.512, .Aulharizillil:tn or Oppmtunitr to Object Not Required.
Notwi#llstandirlg the fo~ing,, an IAS Plmi'lder that is a NHE buUs iiot a
Health care Pl'D'Wder shall not hillYIE! the filht: to make ·the permissive
'.Disd~ de:Scribed in § 164..51.l(c) - Standi!ln:I: Disdos,Llres; aboUt victims of
abuse, neglect: or dllfflestic villiem:e; i 164_512. SUbsectian Id)- Standard:
Uses; and Disdosures tor he,alth O'il'ersight activities; and.§ 164.:512 SubSlecikln
ti) • Staiu:lard: Uses and Disdosur:es to avert a serious lhreiat to health or
safety; provided, however, t11at a.n lAS Pr,DV'ider is not prohibited fi'1:1m
.mat:mg such a Disdosure!s) ifttle lrtdi!i'idltlill has consented to the
Oisdos.ure(s) puB>uifflt. to section .10 of this Conil'l'Klrt ~ e n t
u.1.6 From 4.5 Cflil.§; 164514, Other Reauil'ements Relating tb Uses and
:msc:1osures:
•
.Subse.ctions (aH1:>- Dealing wii:h de-identffitiltioo requirements that
tender il"lfarmatimi not Individually !identifiable lrtormaltkm far
pu!JmieS of this Seaic:in l l 11111d TEftA Securilty lntidenu ·
• SUbsection ldl -Dealmg: With minimu.m ~ requirement:s
•
Slubsectmn lel - Oeilling with Limited :Data Sets
U.l~7 4:5 CfR § 164.522. Rights to Reallen Pri\lilcy Pnnectmns.
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35137
Ul.B f5 Cffi § 1§4.5:21: Ag;eu QfJ[ldjyidyal::a uceptthatan IA!i.PnMdel'that is a
NHE shall be sutiiject to the requirements of Semon 10 with respect to access
bf l~iduals for purposes of IAS and mt Ibis section 11.UI.
tLL9 4:S cm I 164.528. Ag:guntilJI llf Distlq.sures..
11.. uo From 45 Cffl t 164.5301 Mminisb'ative RSJuire~:
1
•
Subsection (a)-Dealingwith personnel desijgnations
•
SubSll!ditm [bl ...:.. ,Deali,_g with tnlinin,;
• S1..mec.tion l'.cl-: Deiilllq with safeguards
•
Sumettion {cl) - Dealing with complaints
te) -Deiillliirlg with s,anctiMs
•
SubSll!dkm
•
SUbse.ttion {fli- Oealin.e with mii'dptian.
•
SUbse.ttion 11).:.. Dealing with refraining fl':om intiimiditil'lg or retaliatory
acts
•
SWsection thl- Deaiiin,; with wanrer of right:S
•
SUbsection fir) ~ Dealing with policies anti pn:11:edures
• SubsecUcm m-Deaiing with dr:ltumentation
112
Wriit:terl Pmlag Policy. Signatmy mU1St: develop, mplemem;, make poollidy avail!i!tll~
anti att in aa:ordilnoe with ,a written priliacy ~licy demibing ilts privacy pmctioe:s:
with respect to lndwiduallly Identifiable lnfmmat:ioo that is Used ,m- Disdm.ed
pim111ant to this Common Agreement and any SOPs. Signatory can satisfy the
written lfflliliCY policy requirement by including .applicable content ,consistent with
the HIPIM R.ulles: in m existing: privacy policy, e,;cept as othe!rwiSe stated herein With
respect to MS Prowden. This written prwac:J policy requilrementdoes not supplant
the HIPM Privacy Rule ,Obligations of a a.HIN, Participar1t, or a SUbpatticipanltthat iS
a Covered Entity to posnnd milltribute a Notife of Pmlaqr Practices that meets the
req111irel:'l'lfflts of 45 CfR § 1541.520. H Signatory is a C,DVelf'ed <itY, then ·ttliis wntte:ri
i::niwc:y po!iiql requirement ,am be smdied bt ;its Notiite OIi' :Pmmcy Practica · llf
Sienatorv is an IAS Pro.rider, then the 'Written privacy policy requirement must be in
the form of a Privac:J a/Ad Sec.urlty· Notiite that meets the requirements of Semon
Ul..:2 ohms Comrm:m Agreement. ~tantlirag S&tioo 11.1, to the ment the
Sii)natmy's Written pmac.y poity e; '"more stringent:"' than the HIPM Pmlaqr Rute
prlll!llisions listed be/low, the written pmacy policy shall go'llem. "!More stnngem:~
:shall have .the meaning ~ e d to it in ,45 CFR t 161U02: except the ·IIV!rli1:ten priocy
polity shill be .!Nllstitl.llted ~rr~es kl :state law anti the reference to
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35138
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"'standards, requirements or implementation spe:ffitm:ioos adopted under subpart E
of pan: 1.64 of this s ~ r " ' shilill. be limited to ti'IO!ii? listed below.
•
12.1
General Security Requinmients.. Slignatary shall mmply with the H~PM SeclJfiiity llhde
if the HI PAA Sec1.1rlty Rule apptied to lndMdualti, Jdentifiabl!e lnfmm.ijiltioo ·th.at 15, Tl
regardless of Whether Sigl'll.tmy is a Co\ilered Sntity or a flusiness Aswi:iate.
Silfliilt:Dff shit aim comply with the security requiements, stat,ed m sectmn 11 of
1lhis Common Agmement and specific ad!:lltiomll n!.quirements as de:Kribed lin the
QTf and applitable SOPs .. With the exception o1: Section 11. 1.:5., none of these
n!.qUirements in $eel ion 12.l shaU apply to any federal :agency or any ,Dither type of
entity ,aeffiflted frnm compliance with this .Section 12.1 in an appUc.sble SOP;
illS
12.Ll. Q(beBeWrity Coytegge. In actmdance with the ·ill:PPlicable SOP(s}, SiglllatDf\l'
shall fflilintain~ thn:iuig,tmut the term of this Common Agreement: (i) a polity
or polic.ies of insurance for qber risk and error:s and omissmm,; (ii) intemi!l
financial reserves to sel:Mnsure against a qber-incident;. or (al some
oombination of (i) and (ii).
ll~l.2 Cyberseoority ~ - Signatory .sha&I athieve and maintain thmparty
cenfficatmn to an irldustry-reco,gmzed cyblersecuritV framework
demmst~ mmpiianc:e wlith al relevant securilty cmtrols, as S•et kll1h in
the aPJJbbte SOP.
12..1.3 Annual SetU11itv Assessments. Signatory must obt,ain a thi~rty securiit~•
assessment and technical audit no less often than annually and as further
desai1bed i1n the applicable SOP... Within thirty (30) davs; of 11'.!cmpletillg such
annual security assessment or tethnical audit; Sig,1\liltmy mll.lSt pr.i::Afide
evidem:e OIF:aimpletien and rmtigatiion as .specified in.the appft'IICabl.e SOP.
12.1..4 Intentionally Offlitt:m_
12:.l.5 SeWflity Res;m.irce Sl.lppgrt to Panitipants. Signa1l'lifY shall make available to
Its Pan:kipants: (i) security resources and guidance l'egarding; the proitectioo
of Tl applicable ·to the Partidpan'ls' partic:ipatioo in the QHIN undetthe
appbble frame\!IIDrt Agreement; and (ii) int'ormatioo. Md resources that
the RCE or Cybersecudty Council male.es a,i,•lalllle to Silr\iilt:Otv related to
pmmotioo and enhincemrem of the sec1.1rity afTI under the .framevmr'k
Ae,eemenu.
12.~Ui Chiel' lnfarmatian Setuljty Officer:
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Federal Register / Vol. 89, No. 85 / Wednesday, May 1, 2024 / Notices
35139
t The ACE :shall designate a person t,o serve as the Chief lnfmmatiicm
Setudty Ofi,cer (CllSO) for .activities condutted under the framework
Agreements. This may be either an employee or independent: comrattor
of the RICE. The RCIE's CISO will be ~iblefor mooit~ and
maintaining the ovenl Seanity Posture of iKtivities conducted under tf!e
:framework. Agreements and mating remmmendations.to ail QHHts
reganirtg d1anges to baseline ,emmy practices required to adclress
c h ~ to t,f!e threst land.saipe.
ii. s.,rtm'\I' qrees tlhat it, and not the Ref, is ultimately responsible for the
Seoirit'f Pasture related to Sigmritmy's pamcipatioo TEFCA. S~1,1nilltory
shall illso designilte• a person to serve as its Cl&l for purposes of.
Sil,lnrtmy·s participation.in lifCA Ex,change. S@illtol'y"s CISO slhall lhave
rre.sp1:nisibiily fur Signa.uny's Security Posture 'with respect to its
pmtidpatiicm in llEFCA E:t<Change and as set forth. in .an so,~ The R.Cf !ihilil
e-sta~iSh a. Cybersemrity•.Coom:il ai entlaince cybersecurilty
mmmensl.ll'llle• with rhe mks d the adi'liities amducted under the
Framework Agreements as set forth in an SOP.
m
12.2
TI ouuide the· United States. Si:gnetoiry· slhatl only Use TI ootside the. United States or
Dis.dose n to any person or entity outside the United State.s to the ell:teflt sud! Use
or Dis.dam ire is permitted or required by Applicable :I.aw and the use or Disdmure is
mm:lucted in Cl:lnfurmance wiilth the Hl'PAA securilty· Rule, feBl!n:lles5 of whether
S.1,111al'liDfV is a O::Nered Entity or Business .Associate.
ll.3
TEFCA Securi1.y Incident Reporting. :S:~iltory shall report tot.he RCE and to all
QHINs h t are llilllieily impattec:I,. whetf!er direttly by ·nature of ooe Of tlhe ,ffl:fler
QHIN's PllllTtidpants ,or .$ubparticipa111t:s, .any TEfCA Sewmy lnddent~ as, .set forth in
the appllicablie SOPls). Sum report must include silfficient informiilltim'i iolrthe ICE
and others affected to Understand the nature Mid likely" scope Oif the TEFCA seturlty
.Incident., Signatmy :shall supplemeim the information amtaiMd int.he report H. •
additional relevant information beci:imtes availabfe and .cooperate with the :RCE., and
.wffll:Dlthel'QHINs,. Partidpan1:5,,illnd5ubpairtkipants that are iliiety impacted by the
TEFCA Security Incident
or
tU.l ,Receiving TEfCA Seig.lrtty Incident Report.. Silgnatmy !ihaH impllemem a.
reporting protoml by which other QHINs am ~ Signatory with a rep<rt
mill TEfCA SeaJri:ty Incident.
•
•
U.::t2 Veftitll R.erortin! ofTEFCA Setu11ty lnddel'llt(sl. Sil,lnilltol\! shal!I report a
TEFCA Securtty fntiderit 11:0 its iP..-ticiipants and Slubpan:idpants as. reqtlm'ed by
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an applicable SOP.
35140
Federal Register / Vol. 89, No. 85 / Wednesday, May 1, 2024 / Notices
.ll.3.3 .Camplianre with Notifiatmn Under APQ!icable Law. Nothing 1ln this: Section
12.3 shall be deemed! to modify or replace any b,reach mtifkatioo
requirements that S~tary may have under the HIPAA !lutes, the RC Rule,
or other Appl[cablie law.. To the extent Signatmy is alreadv i!1equired by
Applicable law U1 notify a Pitnidpant:, SUbpartkipen; or ,anothe1r QHI.,. of 11111.
incmentthat WOUid aim be a TEfCA Sec:11ri1:y lflc:iden:t, this Section 12.. does
not require ~licative notmcaoon.
s
1:2.4
13.1
EngypJian. If SigMJtmy iH NHE (but not t:o the extent that ilt is a federal .agency or
any other type of entiity 9empted .from i;i:,mpliance wlth.thts Section 12.4 in an
appbbl.e SOP), Signattllry.must encrypt iilt lndividuailly l\clentil'iiable Information it
maintains, both in tra!nSilt and at rest, regardless of whether sucfi information is Tl.
ReqUlll'ementsfor encryption may be setfbnh in an SOP.
Complianre vrithApp]icabte tawanct the .F@me:w:grls ,Agreemenu. s~rv shal
comply with all Applicable Law and .sbaU implement and att in :accordance with any
1udin1 all applicable SOPs and
pmwshm required by ·t:hi;s Common Agreement,
pm'll'i!Siom: of the 0.Tf,. when pmilidin1 Ilesiignat:ed ~ Services or ~ e
engaging in er f'a:dlinrtine; TER:A &change..
m
13.2.
Compiiill'Kie with 5pa:ifit Obigatjans .
.13..2.;1 ,Responsibility of the llCiE~ To the exteltt required by the Contract;, the RC£
shill take rre:astinatlle steps to confirm thilt Signatmy rs abiding ibJ the
obliptioos under t'lis Common Agreement, the Q11F, and all applic:abte SOPs.
Jin. the event that the II.CE: becomes aware of a material non-camplia:m:e .with
any ofthe obligations .stated iin a framework Agreement: ,m- ,iillllf\l of the
applkillbie SOPs ti,y· Signatoiy at its ?artidpants or SUbpartidpants, then the
:RtE .stml,i promptly nottlfy Signatlll"J in wrlti~ St.Ith mmce .shalt nmiify
Slgnatmy that its !failure to l:.'.Or'red: any .wck delfidem:ie:s within the
:tlimelfr,ame established tv, the RCE shan constitulle a ma~elii'II breach of this
Cammon. Agreement:, wtlidl may result in termination of thi.s Common
Ag:reement: in a«.0Rla11ce wtt111· Settian 11.S.2.
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13.2. 2 lespoosibility of Signatmy; Signatory shall be responsl:lle Jar taking
•;reasonable steps to coormn, that ,ailll miltS Participants and Subpanic~
are 1bicling try the .ToP and 1hpplicable 5CPs. bn: the ei1ent that .Sign:atmy
becomes aware m' a material norr-c:ompliance by C1111e of its :Pi3111ic.ipani:s or
Sui:lpmfKJipimts, then Signatciry shall prompti'f notify the Participant ,or
Federal Register / Vol. 89, No. 85 / Wednesday, May 1, 2024 / Notices
35141
SubpiilJrtiiapimt in writ.ing. Such notice .sllliilll inform the ,Par!:kiipaM or
~ • tJhiiit its fiiil1.1re to c•arret:.t ainv sw:h deficiencies !Mttlini the
.t.iimefra'lie established by Signaitory shall! ~ a material breac!h oUhe
TDP., which mifif· result in s1.1spensioo mtermination cf hrtk'1aint's or •
Subputiloipil!l'lt:'s ability to engage in TEFCA Exmange, .·filooept· as .set forth in
Settii:lnl.7,4. 5, ~ is resp::msilblie for determining when suspe,u,iim or
termination Of its Participants' 01 SUbpartidpel'M abfflity to engqe in TEFCA
,l:Joohange is witrran:t:ed. Nothing in this Section 13.2.2 shilllJ be deemed to
limit Svnamf'Y's n!:spoosibil!ity for the acts or omissions ofits Pilll"Udipants alid
Sul:lpridillffll'lts i\lS set forth in Section 7.4s
13.1.3 Flesaonsibilil\l' for ~Pam Teclmotggy Yffldors ,of stmm:my. la the:
extellt that Signaitory uses a. ttlird-pany ta:hm:liogy vendor(s) 1:lhm: will hive
access to TEFCA lnformatm iiri conl'lettion with Designated Network
Sel'\!ke, it mall intllud:e iin a writtefl agreement with eaclh sw:h s1.1bc.antrac:tor
or agenta l'leql.lirement ta c,ompty with all applicable provisiians ohhis
Cammon Agreement and a pr,ootitiiicm 011 engaging in any act or omissii:m
that wm.tild amse Signatnry to violate the te:rms of this Cllfflman Agreement
if Signatltlf'il' tlad engaged in sud! act m omissm iitself.
13.3
llntentiona:IJx Oi:nitted.
13.4
llntentionally Omitted,
14, Specific QfflN Oblieatm;,
14..1
Trammrency-Acoess ta ParticiNnt/Stmpartic:mam: Information. If either QiNC or
the RCE .has ii reasonable billsiis to believe that one or more of the fbllawing •
situall:iom emt with .respect tiO S.1naitory, ·dlen Signatory .shilll. make available, upon
written request, ewdence ofthe: apptiicabte Partk~t;/Stlbpartidpant Terms of
Pan:idpilltion am:! informatk!ri relilti!'ll ·to the: exchange of TI and the dn::umstances:
g,i\lirlg rise tD the basis for such request. The foregoing shin be subject to .Signatol"(s
right to reslttia or tt:lnl:lltion its ~per.iitioo or disdcsure of information in the:
interest of. preserving privileges lmlt onty to the extent that sUcih ilnfmmatian is
materill to the: deff!He of a substa1nt.ated daim asserted by ,a ·third party~ Such
siltUilticns indude: an alleged. \liolatkm. of this common Aereement or Appkabfe
law; or Ii) a: threat ta the se«1rity of lffCA &change or in.fmmilticm: that the RC£ or
ONC rea50f'liiilb!ly !believes is Tl. The right of S1111atory to riestrid: or mnditkm its
cooperation or diStlomre of information $JUfSlmnt to this Sectitm 14.1 in ·rt:he interest
of presaving ,privileges shiillll not apply to ii disclosure thalt is requested in the:
•imerest of natiooal seOJl'ity.
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35142
Federal Register / Vol. 89, No. 85 / Wednesday, May 1, 2024 / Notices
14.2
Cgmpliang: wjth $DQdao1 Qm:@lim!; Pt:gc§lg[§. The Rtt: sl:!aRI! ad~ Stllldard
Operati1~g Aror::edures (SOPs) to pr,Qllliide tleta:iled guidarn:e on specific .aspects of the
i!ltimange ai::tMties under.this Common Agreeimel'lil: that .are binding on 1he RCE,
S~atory and, as appliia!l:llle;. Participants and Su~ms. The .SOIPs. are.
inoorpomted by reference into this Commoii Agreement,· and Sig;natuy sl:!al comply
with ,al SOPs ·that are appiical:llle to it. In the To?, Participants and .sutJp;utidpam.
will aeree to comply wiith al!f .appliaibie SOPs. It Signatory or ib PanJilcipants or
SiJbpartici!pann :f'ii4 to comply with ainy i!lpplicalble SOP., the EE ma.y take ~
actiionto bri!ngthe organrzation into mmpliilooe wiith the SOP, which may include, ~i)
requiring Signatory Ito suspend 1he ablliqt of ,iii Participant er Subpanidpilnt l!'O
exchange ilmmmation under the :Framework Agreement(s) um:il 1he ncm~liilll'IICe
is •t:mrerted to the misfuctimuit the RCE; (il r,equiting Signatory to terminate the
ability of a !Participant« :Subpartidpam l!'O exth;.mge information under 1he
framework ~ent(s);; (i:iii) suspending :5ien1tory's abHlty to e:ioc:hange
fflkllrmation under the Common Agreement; or (w) t:erminatq Signatory's .ability to
exchange mfmmatmn under the Commoo Agreement. RtE shall adapt .sn SOP that
pRJIWd-es detailed information about s:ancttons ·fi:w· non-cc,mpliance with ill11 SOP.
Nothq in this Section 1.4.2: Of this eomman Agreement limits the RCE's rights: to
terminate: this Common .Agre.iement under Section 11.32 or .17.J..3 Of this Conimon
Agreement:.
14..3
'1inte11tiona1ty Omiitteld.
14..4
lntentionanv Qmiiil:tel:L
15.l
Acknowledgement ancf COOS:§lt m Di:spyte Resmution Process. Sil;111tory
acknowledges that it may be in its: best interest .to res,ofvte Disputes related to the
Common .Agreement through a eoillabcnt:ive, a:ilegiilil
mttter than tl:!rcu.Qi:h
civil litipt:1011..Sigr'l1tory has n!illdled thi!i toncllBil.:m biilSlt:!d il.lpcffl the fact thilt tine
legal and.factual is$Ues related t•D the e:JCthange and related activities il.lnder the
Common Agreement i1l"e 11.1nique, l'l!t:M!I, and ,c,cmplex; and limited •tiilSe &aw Si5ts
tilat addresses the legal issues ·llhat cou1d arise in cCll'lftettian Mllh thiS Common
Agreement. 11hef',emre, :Signatory agrees to panidpat:e m the Dispute Resolfution
Process with re.spect to ainy Dispute.. lllot'wlrn:ttlstanmng,. Signamry ul'lderstanclS that:
tile Dispute Resolution Pirm::ess does not supersede or replace 111/1/ oversight,
ilnvestigatory, enmrc.ement, or ether ildmmistrative aaicns or pmce.sses that may be:
taken by the relevant aurlhonty, whether or not arising out Clf or 1related to the
dm.tmstances ·:P'llffll rise to the Dispute. RtE •and• Signatmy are amrmtted to
pm~tiy and fairly resolving Disputes..
process
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Federal Register / Vol. 89, No. 85 / Wednesday, May 1, 2024 / Notices
35143
To that end, Signatory shalt UJSe its best ·effam m, resolve Disputes that may
ame with other QHINs,: their· respective Panidpants and Uparticipanu, ,or the RCIE
through immmait disc.ussians before seeking to mvoke the: Dispute Aes,olution
Pmc:es.s . .Likewise,, Signa.wry~ on its own behatl' and on behalf Of its ~rticipant~s) or
Subpnopantfs), will seek to resolve Disputes involving the RCIE thn:111¥1 e:oocMaith
mfmmal diswssioos wirtl the RC£ prior to invotmg the Dispute Resdll.lticn Pr«ess.
llfthe Dispute carinot be res~ved thl'OUgh mcper:atian between Signatory and the:
other QHIN{s} or the RO:., then .the RCE m~. ,er Silgnatmy may on Its mun behaif Q.ir
on behalf Of its Participa~) or .S.Ubpartkipant(s). d!oose to submit the Dispute to
the D~1.111e Resolution Proce!iS,.
Under oo, cirtcums:taras wiffl the Dispute Remliution 'PrOi:eu give ·ttli:! RCE any
pawer to assess, monetary diif'.Tli'lges against any party to the Dispute Resotutiion
Pmcess ir1dudine;, without limiltatioo, Siignatory ar its Participants or ~anm::ipants
or any other QHIN or its Participants or Subparticipants. Except in ,ilttm'dance with.
Section 15.2, if SiigMtmy refuses to pal'tidpate1 in the Dispute· Resolution Proc:less,
sudl l'ri.mll shall c,anstitute ill material breach ,of' this Common. Agreement and may
be ie,ot.mds fer suspensbl'I or termmiltmn of' Signatory's participation in TEKA
fn:.hange.
.15,.:2
'lniHct:we leiief:
152.1 Notwithstilndine; Section .lSJ,, Sigmtory shalll be relieved C!f its Dbligmkm to
pankiipaite in the Diispute Resol1utbn Process tr Si1111atory: (I) malk2.s a good
faith detemlimmt>n that is based upon iN'aHilbk! infmmiltion. or other
evidence that ~ QHIN's or its .Pilrtitipants' or Subp.1rticipants,' acts or
omiis!iions wifil 11.'iOlate Sedan 7.1 or cause in'e!JiilralJle harm to Signatory or
another orpnization or persoo (e.g.,, another Q.HHf or its Participant or an
lmlimuid};. ,and {iii) puc:sues immediate injunctfive ffl!ief against sum QHIN or
iits Participant or Subpalticipant in a court of competentjt1riS:dk:tio11 iin
aa:ard11nce with section l:9.3. ~ilt•orv must flOtifV RO: of .mdil attmn
'Wilthiin l'ilfDi (2) !business days of filing for the: injuncthle relief 11.nd of the resullt
oft.he attioo wffl'li;n twenty--fmlr ,(241 m:rurs Ofa court of <JDmpetent:.
jurisdidiion gnintmg or denying mjiundive relief~
1
1:5.:2:.2 •ff the inj1111'1Cttve l"ellief ~ t mSettmn.1.5::Ui.s oot gra1ted a1.d Srgna.tory
Chaoses to pursue the. Diisputie, tbe· Dispute 1miJ!Slt: be sub~tted to the ffispute1
R,esollftiDn Pl'Oll!ss in ao:ontance w.lth Section 15.1.
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Activities during Di!illute R.\esdytiion Proce!ls. The pendem::y of a Dispute under this
Commicm Agreement: has oo effect1 on elth.er Party's 01bl.i:ptiol'ls hereil'I, unless
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15i.3
35144
Federal Register / Vol. 89, No. 85 / Wednesday, May 1, 2024 / Notices
Si~atary terminates ilts neh!S m accardaoo:e with S:ection 11.iu ,or is suspended in
accordance W'iith Sec:tioo 17.4.2.
•
15.4
tmpjlemenmtiol'I of Agreed Upon Resolution. .,~. at ainv poillM during tile Dispu1e
lesiclutim Process, S ~ and all other Jffll1lies to th:e Dispute accept. a propm;:ed
resdutioo of the Dispute, Signatory and ACE. eacih agree to iniplementthe terms of
the resolution wwthin the dmeframe agreed to in th:e resolution of the Dispute, to
the ext:ent apptialhte to each Dftheni •
15.:S
Reervatign of Rights. l'f, follO'!llling the completmn of the Oiispute Remlution
Proce55, mthe opinio111, ,Df ei!:hef Paif'll~ tl:le· Dispute Reso!Ulli1i:m•Pmc:ess failed to
adequately resdlle: the Dispute,. a .Party mav p.tBue any remedies available ·b:I it in a
murt Of c,ompetent jurisdiction in ,Kcordance with Section 19:3.
•1s:. 6
.fscalitii0111 of t:ertam msootes to ONC. Except far .ICE suspension or termination
dedsiions subjeict to Section 16 of this Colmmoo ~ent,, if ~~l'f has reason
to beliieve thiit: (i) the RCE is acting in a Discriiminatory Mamer or iin 'lliolmion ,Dfthe
RCE's conflict of interen policies.; or (il tile ACE has not acted in ac:mrdan:ce: with Its
obligaltjims ·stated m.this Commo111 Agreement. then Sjgnaitory shall have the right.
on its awn behalf and on behalf.of its Participants and Subpartkipsrts, to make a
complaint to ONC.. The complaint shall identify the parties to the Dispute, a
deJlription. of the DiSpul:•e, ,1 summary of eidl pany's position on the i&sues inauded
the [mpute., the fiMI dispo!llition of the Dispute, amhbe basis fur the RCE's:
·. alleged miscond!Jct. Tiu!!· ACE and Signatory shall each also promptly provide such
additional information as may be reasooabdy requesited by ONC in order to consider
and resdve the issues raised for review. Since thi!i ,cumplilirlt may im::h:Jde PHI a.nr:I
may 1111dude Co111fidential lnfmmation, the RCE !Ml 'WOB: with ONC t:O ttevelop
mechamrns: to i:,rotec:t the comdentialitl;! of 11:hts mmmatmn. Such protect:i'lle
mechamsms, amUhe pnxes!, for escalating a ,cl0fflplmint to ONC are setfmth in 111
m
SOP.
15.7
lepmtim! of Arionymiized Digyte trifOl'ffliltiOO W ONC: . As p1n of tile RCPs
.communications Vlrith ONC, within fifteen (151 ltmsiness days after the end of each
calendar quaner, the RCE reports 1he fOliowing infurm1tio111 rel~ to e.acb Dispu1e
th1t has bee111 .wbmitt:ed through the Dispute Resot11tioo Proc.e.ss in an anonymized
format ta ON(:; i(i) identification of whether the i:iauties ·to ·ttie· [lsp1.1te are 0.HfNts)
ontv, er whether the Dispute also itN'o!l'!i'e'SP,artidpam:(~I Qr Subpartidlfflnttsl;. ~11 a
demiptiml llfthe Dispute with reasonable. specffitity; and (iO the fil'lil di:spmition·of
the Dispute.
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16. Appeals to OIIC.
Federal Register / Vol. 89, No. 85 / Wednesday, May 1, 2024 / Notices
16.1
35145
SlgniitDfy may appeal the following dedsians m' ll'l1e RCE kl ONC:
16.:1-1 Suspensiion ofa Signato1y or .Suspensilffl of a Sign1tol'(s Participant. or
Subpiilll'ti:cipant; and
16.l.2 :termination cf' a s.lgriatmy"ii Common Agreement by the RCE.
16.:2
ONC anticipates publishing regulations to address the appeals of.iiiny of the RCE's ·
detisions listed in Section 11,i..1~ ONC anticipates issuing sub-regulatory guldance to
address ·th,osie appeals while farrm:Jrting l'eglJBiltians.. Until ONC~s regutatioos
govemiing those ~peals are finalized and effiective, the· sub-n!gulatary 11,iidaiooe
mn: .issues shall !be: biim:lirw under this common Agreement.
U. Tenll\, Tammatiml Mil SUspenaon.
11...1
Term. This Common Ae,eemiem: shall commein:e lffl the CA Effect.we llm:e and shall
remain in effect until iilt: .is temllinated by either Paity in atJmrdance with the.terms cf'
this tom1mon Agreement.
17. 2
lln:ten:tionally Omiitted.
17..3
Terminatiim.
.11.3.,l Termination by Simatow..Signatory may terminate this Common Agireement
at any time Witlmut caus.e by prw~ ninety (90) days' prim- Written notice
to RCE •S~natDiy m.ay al:m terminate fon:ause H'the Ref mmmits a materiilt
breach ,of'the common Aa,reemenrt, and the RCE fails: to ,cure its material
breach within ·thiny· (30) days of Sienatarv providing written not.ice to RCE of
the material breach; pmvided,. lmwever, that if ACE is, dil~ntly working to
ane iits ffliiltel"iill b11eacll at ·ttie end of this thirty (30) day period, then
Sigrlat,my must IPl'O'Wde 1he :A.CE wiiltih up to aootl1e1r thirty ,[30) days to
complete ilts cure.
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17.3..2 Termination by the RCE. RCE may mit termimne ·this ,CIJmmon Agreement
except m provided by Sectioo 4::Z., this Section 11.3.2, or Section 17_3.3 of
1his CommOl'I Agreement. RC: may taminatetbis CmnmooAgreemerit with
immediate effect by gj\lling lldice to s.\gnatory iif: Ii) Sigjnatory is in material
breach ,many of11'11e terms andcondiltiiti::ms of this Cmnman.Agreement and
fails. m remedy such bre,ach within thirty (:Ki} days after ~ n g f!Otice of
such breach; provided, hDwieYer, that, if Signatory i5 dliigently womng to cure
iits material !bre;ach at the em:I of this t.tmy- (30-) day.period, then RCIE must
provide :Sigrmt!l:iry with up to arwtherthiny (30} days to ,complete iits t\l"e; m-
35146
Federal Register / Vol. 89, No. 85 / Wednesday, May 1, 2024 / Notices
(ii) Sigmltmybreaches a material pl'O'llision mthis Common Agreement
Where sum l:lread'i is oot ,c:iillpable of remedyi.
11.5"'3 Terminiltkm.by RtE iifthe RCf Ceases to be Funded. The Parties
ad:110W"ledge that the RCE's actiiwties under this Cbmman Agreement are
supported by DNC fun1:Hng. lif this Mlding ceases, there are no parantees
th1t ·!tlhe RtE. will
sustainability model has been
. continue unJeg ii m;mcial
.
put mpla~ If federal funding ceases, or if the a'ill'ililabte.funding .i!S: not
suffil::iiem to PR.Miele the nece:s:sary funding to support • ~ m of the ACE
and there is
sucressor R<::E, then the RCE ma.y terminate this Common
Agreement b y ~ ,one hundred and eiehtf (180) days:' prim" 1dl'l'ittein
notice to Signatory.
rm,
.17~Si.4 Termination by Munlal Agreement. The Parities maytti!rminate fhiS.Commoo
Agreement at anyt:ilme. iind for any treason by mutual, W'litt:en il)rttfflent.
..17.3.5
.Elfect ofTerminatmn gf ttre Common .Agreement:..
Upon terminatioo afthisCommon.AgJreement: liOr any reason, ACE
shall pn:.tn1p11Jy remove S~il'kll"f and its .Panicipants and
Sl.lbpilltildparm ffo,m the RCE Directory Senl'ite and. any othef· lisu
of' QHlllls that RCE maim.ail'll!i. Signatory shall implement the
technical med1anism!ls) necessill'.Y to ensure that its Participants"
U)
and Subpartic~ts• abiity to participate mTEftA &dumge is
terminated I.IJPl>R temntlon ofllhii!s COmmoo. Agreement.
(ii)
Upon termination afthis Common Agreement !f'°r any reason.
S&e,mnary shall:, without undue ,delay, (a} remove· aH refen!nces
that identify :it. as a QHIN from all media, and ~} cns,e all use DI'
any material, induclq but tmt limit:ed ta, pmduct fflii.ifflliilllS,
marketing literm:ufe, and ~b c:ontent that identifies it as: a QHI.H.
Within twenty (20) l:Jusiness days of' ltemlifiation .of this Common
Agreement,; Signatory shall c,oofii'm to RC~. m wming;, that it has
mmplred with this Subsection 17.3.S(ii)..
(iii)
To the extent S~!Jliltorv sttlfS 11, such TI may oot be
distilnguiishallie fn:lnl. other infmmiltion 1:1•1,;drrtained by S.gnatary.
When the TI is not ~ a b l e fi'om ,mhef infoirmatim, it is
nm possible for Signatmy to return or destroy 11 itmamain:s upm
termination are,cpiratiml of'thfs Common Agreement. Upon
termination ar e:111Piratik:m of'thiis
Common' Agreement, if Signai:my
"
115: wbject to, Sec:tii!on 11 of this Common Agreement. such sections
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35147
shall mntinue 'to applly m long as the infDffflilOOlll 'WOUid be eJl>HI if
maintained by a COYered &mtv or Biu5iili'lessAmltiate. Tne
protections: required llll'lder the HIP,M. ,!iecurlty Rule shall aim
conltinue to apply to all 'TI that is ePHI, isegardless of'lilllhether
Si;gnBtimy is a Covered. Entity ffl" Business Auotiate.
,(iv}.
!in no event shall S~ll)l'liiWny tie enltided to any refund of any tees.
that ii: has paid the RCE prior to terrmnatiian.
,1v)
The prO!tisions set fOl1h m this Seamri 17.!5 are in aclditmn to
those survival provisions set fOl1h in Secl:ion 19.16.
11Al. SU!Spen:slion bJ RCE. RCE may .Sl.lspentl Slgrialmy's ablllly to ~ I i ! m lEl'CA
fx:ic:hcmge if .Ra detem1ines, fallowiq mmpleticm of a preliiminary
investigation, that Signatory is respoosible far a. Threat .Cc:n:llticm ,or in
a.ttordam:e with Sertioo 17~4. ACE will maike a reasonable el'lfmt to notify
SilnltOll in adiiani::e of'RCE's intenuo suspend Signatory, im::11.11dii1'1 notice of
the Threat Col'i.diitioo gi,wng rise to sud! suspension. ff adviil1tf! ~te is not
re;amnably practitalblie under the dm1mstam:e~ the R:CE will notify Signal)my
of tire suspension, and ·the lhreat Omdiltion giving riR thereto, as
as
practicable following 'the !iU!ipensioo. Upon suspension of Signatory, RCE will
wtiril;• collaiboratweiy wmi $lenitltlry to resOfft the iss1.1e leading to the.
sus,en.S1i0n. •IIICf .!ihlll adopt SOP to address specific requirements MK!
timelines related to suspension.
•
•
•
soon
an
11.4.2 Stlettive SfflpffiSjicm by Sjgnln:90'. Silftatoll may, m good filllth and to'lhe
Eldie:11t permitted by Appliicable, Law, determine ttmt it. must suspend
HChilllllil'II with another QHIH; Participant, or Sul::lpanklipant with whkh it is
otherwise required to e.Kbange in aa:.ORliHltte: with an SOP ll:lec&i.se Of
i:ea:sonable and 1$timate cmc:ems related to the pmiacy, sewriity, accuracy~
or quality of information that is: exthang;ed. If Signatory makes ·tms
detenmretioo, itis requil'll!!d. to promptjty 1notify the 'ICE and the OJIN ·mai:
Signatay is suspendif11: of its dedsicm ilnd the reason,(s) for making the
decision. If Signatory makes the detil:Sion 1:0.sll!ipend, .iit is irequired;. !Miithin
thirtV {!OJ days, to initiate the mspute Re.Slellllltion Process order tt! resGl.ve
'li'llhate'li'er sues led ltO the decision 11.D suspend_; or en1Ut:s suspension and
l'illS,IJffle ewthilinging with the ,od\er QHIN. Provided that Signatory .stilectw,ely
suspends exchangiq with iH111ther QHl!,N in aa:on:Jlanoe with this Section
l7.4..2 and in ac:a:irdilm:e Wl:t1h .Applia~e law, sw::h 5eliectiiile ~ · shall
nai: be dee11!111!d a malticm Of sectien.s 6.:2:.l or 9.4..
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17.4.3 .Additional SU'lipemiioo lif$;15 cf. RCE" Nat'Mtrutanding anything to the
conn-ary set. forth herein, ·me Ref r¢tffl!S itl'l'e. rtght t01SU.spend ·il'l1V lEFCA
ExchimJe Kmliity '(i) upon ten (10) days' pr'ior nmke if tl'le 'RCE detem-iines
that Signatory has created a situation in which the RCE may suffer materral
hmm ,illfld SUSJH!f15Hffl is the on!y feiili.SOl'li!lhle step that the RCE tan Qke: to
protect itself; or (i) i1mmediately if the RCE detenniines thaithe Yl'ety· or
security ,of any person or llhe prii,vaiq or security of TI or Confidential
lnfonnaticm is threatened.. In t:l'le ca.se, of .an immediate suspensmn under
this Section 11.4.3,. the ACE will pn;J'Vide notice a.s soon as p,acticable
fotlowing the swpensiioo.
17.4. . 4
•Effect ofSt151pepsion.
The suspens.ion
or· SigrlatDry's illbiliity to participate in
TEFCA Exl::l'lil'!fle ;n.1rsuant to this Section 11.4 has no ,effed: cm Signatory's
other ,obliptii10ns hereunder, including, wit.l'lout llirmt:atioo, obiigaUoos With
respect to privac:y and security. Durinl any suspermon pumiant tD• tNs
Sectiool.7.4, Signatory's millbilityto exchange inful1Mtion um:ferttm
Cammm Agreement. ar amply with those terms of this Common Agreement
that require information exclhqe shall noU:ie deemed a breach of this
Cammon Agreement In tl'le event of susperisil:m of S.e,i,ator(s abii'!y to
pwtiiciipate in TEfCA bchange, SilnatofY shaH communicate to its
Partkiipants, and require that they communicate to their Subparticipants,
•that all Tl:fCA Exchange by· or ,cm behillf of Signatory's Participants and
~ - wim also be suspended during any: period of ~ s
suspension. 5ienatory is responsible for lilmng and i:nplementing ttie
technical me!chiinism,ts) necessary to ensure that its Participants' and
:S~ant!i' ability to piirticipalie in TEfCA Exthai,ge: is suspended during
the period of Signatory's suspension fmm TEFCA i:llchange~.
17.4.5. RCE :Suspension. of 'Parllkiipant pr Subparticma!nts.. lo.the extent that .ACE
detenniines t:hC one of Signatory's Participams or Slubparticipams has done
something ,a,r railed to do SQfflething lft,at rerults m ii Threat Condition, RC:E
fflil\l' suspend, or.the RCE may direct that Sill'littmV suspend.s t:hC
•
.Pamoipant's or!il1.1bpanidpant''s abii'!yto ,engageinIEFCA &.change. ln1the
ewent that ttie RCE directs SigMtory to, SU§ipend ,ai ,Participant ar·
s ~ a n t based on (ii) the Ref's determination .that suspension m
termination is warranted based oo Olan alle1ed vmiaticm m' such frame'Wi'Jl'lk:
Agreement or of Appliaible law:~ the party/parties; I~) a cognizi'llb&e threat:
to the security of 11:f'CA Exchange or the information that the RCEreamnably
1111:iieves is TI;. or Iii) sudh suspenskm its in the interests of national security as
directed, bf an ~ d the United States gmremment, then S.gnatmy must:
effectuilh! such susipension as .men as practicable and notI ~ thiH'I within
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Federal Register / Vol. 89, No. 85 / Wednesday, May 1, 2024 / Notices
35149
twent,-fuur fl4) boors of tile RCE having di1rected the .suspension, unless the
IIICE 5')etifies a I ~ period of time is pem:'lttl:ed ta effectuate the
suspensiient; ii!llld ilt>I ,1n,r reason other thin those in subsection (a), .then
swiatory must efl'B:tuate susipem;icm as soon as practicable.
17.:S
sua:essor RCE and Transition.· :SieMltmJ agrees that ONC has tlhe right ta select any
successor RCE or to act as an interim RCE umM such s1100!ssor Ra: has been
sele:tted. Signatory ftlrti'ler agrees to work toope:ratwely with the R:CE and il'IIY
interim m- wccess:or R.CE .selected by ONC. Additianall:y, Signat:ory :mall toritinue to.
abide by' the pl'O'llimms of tills c:oimmo11 Agteement dwmg: the transition to ,ariy
mt,erim ar .succesmr JI.Cf.
l&.fees.
UU.
!Fees Paid by gHINs to the ,RCf. SW!atory.sl'lall pay the ~ee.s setfortll oo Sched1LJ1e 1
•attached hereto (the ""QHIN fee.S'"). Ref .shall irwmc,e Signatm"y for ,aJ!t fees in·
acmrd1mce W:1ith Schedule 1.. Unles:s atherwi5e set forth mSchedute.1, il!VOices shall
be due and p11able by SignatorV writihin m:ty (SD) days after remiipt thereof unless
S~atory nmffles RCE in. wnting that. iit i.s Cbnliest'ing the. aCC!Llf:iKY of the imllice and
1derttim!s the s)'l!e[itfit milltaloo'ies that it aSS'/ert.S. · QHIN !Fe.es. tolllte!ited under this:
Senion 18.l shal be resolved between Signatory and RCE as stated in the applimble.
:SOP. Other th1m with regard to in!/Olced amll1Ul1U 11:hat are mi'ltested in good faiittl,
any coHedion costs., attmneys'. fees, or ot:tiew elf!Penses reasOOillbly iincurred by .Ref in
adlectilng amounts due under this Common Agreemiernt aire the responsibility of
swiatory. If S~rv faiils to pay lll'IIY' undisputed QHIN fees when due hereunde~;
Ref has ·ttJe right to .suspe.nd or terminate, Sipatory'.s ability tt1, panitipillt,e many
exchange act:Mty·under thi!i tcmmon Ae,lreeiment. Prim to taking 1111y attioo illtamt
Slenat•orv for nan-payment~ including suspension, RCE sllal provide .SigmltDfY ten
(10) days'. prior W!l'iittein natke. tf SigllatDf'\I' makes 1payment within ten (10) days .of
receiiviq written notice,. RCE will not suspem1 SignatOry's abHity to partidpate: in any
exchange actmty· under this tcmmon Agreement. If Sig:1natory fails to mate
payment withln ten (llJ) days of receifing mmce,. then tile RCE may implement the
~ n or may terminate: Sig;l'latorys amity to paitidpate, ill any exchange,
attiw,ty under this Cammon Agreement:
.llU:.l Chamres to gHIN Fees. Schedl.llle 1 may be updated by the RCE 'lrom l:ime-totime, iin rela.tiOn ta operaitwnal costs, availability of ONC fuodinl, and other
market factors m order to ,ensure the sustainability of the mivities
0011ducted under the framework. Agreements. In ligll.!l>Df the foregoing.
manges to Schedule 1 are not subject to the ch1mge management process
seit: forth imtSettion 5. The RCE shall p r ~ S~torv. not less tl'lan rilnety
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35150
Federal Register / Vol. 89, No. 85 / Wednesday, May 1, 2024 / Notices
,t!ID) days' ait:Mlnce written notice of any ;u::ljustments to the QH1N fees set
~ iin Schedule 1.
1&2
fees Char,ed by gHINs ttli Other QH:l!Ns~ Si~l'l" is pmhibited lfrom.dlaqiing fees
to other QHINs for any ud1an,ge d information uSing the Designated Networt
.semces.
18.'3
fees Charged by gffiN.s, Participants. or Sutmamgpanu. QHENs, P.liticlpants,. and
S ~ t s !!:hat operate a 'llespoomng Node mav dlarge fees to an ll'lilia'ting
•M:lde when ~e~·b:I Queriesthi1:l~h TffCA Exdiange asdefmedm an
appicabi!e SOP. The forego~ shall oot: prohibit Signatory fir0m charging i,ts
Pridpanu or Subpartkipants.fees for U!ie of its Designated Network. Services.
19. Cootrl!Ct Mmiaistradon'.
l!U
Authgrity to :&ewre. Sjgnatol)! wamnts and represeni:s ·that it has: the full rpower·
and authority to ~ : e this Cmmm::m Agreement arid that ill"l'\I' represenilative of
Signatory whoe~ this Commcm .~ent has NII power arid ilJIJthorttymdo
m on behalf at Sig;natocy..
19.2
:Notices. All notices to be .made under this; common .Agreement. shall be re.wen in
writing to Silflatorv at the address for lqal notice .specified in Its QHIN .Appilicati,on
and to the .11a: at The Seql.ll:lia Pmjiect 8300 Boone BMi, Suite 500, Viema, Vi!'lffliil
22182 or roe@.seqm:iiapn:ij,a:U11"1, and shill be deemed givlen: (i) i$on· delivery~ if
penonallJ delivered; (il upon de.livery .by :D\lefiflig,ht delivery semce such· as UPS or
FEDEX: or another rec01nizell mmm~I earner; (iii) upon the date indic:ated oo the
rewm receipt, when sent bf the U111it:ed States Postal Service Certified Mai,. return
receipt requested;. or (ill) iit by faain:tile telecanimumcatioo or other form of
ellectronic:; transmissiol'I., 1.1poo receipt when the sending faaimie machine: or
electronic:; mail address m:::eives: ooolfirmation of receipt by the receiving fatsiilmile
mad'iine or electronic maiil .address. Either Piny may update its addfess ror notite
lby providing notice to tile other Party m acmrdance wi'lh tlw5 .Seaion •19.2.
19.3
G011emng Law, Forum,, and Jur'isdktilffl.
19.3. l Conffic:;ts of Law and Goiiteming law.. In the •event of a Dispute between·
Sie,'rliltory rand the RCE, the appticable federal and State coltt'liias of law
pm111isiCM !!:hat pem 1he operations of the Parties shall determine
governing law.
19..3.. 2 JIIJrisdigl[o11 and venue.. The· Ref, currently a Vii:giima non-profit mrporaltion,,
and SqJnatorv eam hereby submits to 'the emusive jurisdiction .of any State
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35151
or federal ccun: sitti.ng iin the Commonwealth .of Virginia wfthin twenty-fwe
(25) miles of Al:exandlia, Vir:ginia in any legal proceeding arisltng Ill.It of ,or •
relating to this O:immmi ~me:nt unless 01:ti'erwiSe mqU!ired by Appiitalble
I.aw: The RCE and Silnatmy eath ae;rees that ail! diiliiims and matters ariiilng
olift. of this O:imnmn .Agr,eement may be hean:I and determined in such ,coon,
and each Party hereby Vl!ahtes any light to object to such filing on gro1.mdsaf
improper venue,famm r1,11l'H:'l:m~s. or other venue--reliilted grounds.
1
19.!U
lntentiomHv Omitted..
19.,3.4 Sovereign lmmunity. No prffl.!ismn within this Cm:nmon .Agreement. in any
way ams:titiutes a w.11Ver iby ·the United states Department of Heililtti and
Human Services: or .iilfiV other part ofthe federal go11emmem of ~ i g n
ifflm,Llnti:y or any other applitilible 1mmunity firom .sut or from liabilitlf that
me United States, Department of Health and Human Seinnce.s or other pan .of
the federal government may hifflre· bf operation of 1law.
l!U.
As!iil!!lnment.. Nooe .ofthi,s Common Agreement, imudi1111 but nm: lim.ited to any of
•the rights: creill:ed by this OJmmcm .,Agreement, can be transferred by e:ill.1her· Party,
whelher t,y· mignment, irner:ger, other open:.tim of law, Change, af comm! of the
~arty or IJlll'lerwise, without the plior written appll)'ft:i!il of the other Party;
Notwilthsulndi,ng the· fcregoi111, if aft selects another or:gamilticn to sel\le as ·tt,e
ICE, then RCE shilll ,1SSi!l)n this Common Agreement to the sua:essm RCE .or a.n
mt,erim RCE as directed by ONC and ,c,onsent of Sigi"litt:Oll· t,a, su:h mgmnent shill
oot. be required..Signatory under.stands and <11reeS that no. interim or succesmr RCE
mall hiMHi11y obiligati(m or liability fer any att or omission of The .sequoia Projett in
co111net100n with this Olmmon Ag,e.ement: or any of the other framework:
Agreements prior to1 the termination. of The Sequoia Project's .status as the. RICE.
19.5
lFO!!'Ce Majeure.. Neither pi.arty $'hirll.f be respomlib!e fer any del;iys or faiture.s in
perfarrr1.11,ce caused by the occurrence ,cf events or other cira.tmstam::es. that are
beyond its: rea.sonable cootroi after me 9en:is,e of ccmmerdalty reaS1>n.1bte .effiorts
to eii:ther prevent or mitigate die effect of any such. oc:c1.1ffel'lce « ,e\lS!t.
19.6 •kxe:@bjiliSJ. If any pn:MSioo of tihi.5 Common Agreement sha/11 be illdjudged by an,y
court of "ompetent jurisdittmn ·tt1· be u1nenforceable or invalid, that provision shall
be stnleik. from the O:immoo Agree,neat and. the remlinq p11:MSioos of this
Olmmon Agreement sllal remam in full iforte: and effett and en'lorceablie_
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counterparts. This O:imman ~ e r t t m;iy be aecuted i111 one or mare
counterparts., eadi of wtiidl shall !be considered iil!'I Driginiil cot.inter-pan,. and shall
bemme a·bintling: ,agreement Wht!ri ei!Jdh Party sull hi.ve exe::uted one •CDtllnter:part.
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Federal Register / Vol. 89, No. 85 / Wednesday, May 1, 2024 / Notices
35153
incorporated herein by reference; and (\lliiii) other RCE plans, doo1.11nents~ or
materilils rmtde available relillf'ding activities coodooed um:ler the framework
Agreements.
19.14 QHIN .Time Periods. An1J Of the time periods rellalt'ing to the Parties hereto that are
specified in this Cammon Agreement may be c:Nnged oo a aisHJy-CHe basis
pursuant to the· mutual Wrim!n consent of the Parlms~ provided. thatthese changes
are not undertaken to adversely affett: .ilil"IOther QHIN and pn::iviided that these
t h ~ would nm: unfairly benefit ,either p.arty !tO ·ttte detriment of others
pilt1iidpii1tiirlg in actiiwi'ties. under the lirame111mn: Agreements. Time perilods thiit
1pertain to ONC mii!J not be th;mged, ex<:ept by ON~ indUlding the tlme periods ·ifw.
ONC review o f p ~ d1a111es !tOthe Common Agreement~ the QTF, or SOPs.thlt
are set fl::lrtt'I in Sectii:m S.
19..15 Remedies Q.imulative. lhe rights arid remedies .Clf the. P•iirties prowded in this
Common Agreement are cumulatwe and are: in addition to any other lights and
remedies pn:wided by Appl,icabie law.
19.16 SurvNBI of llghts ;mci Oldgions.. The R5peetive: rights; obligations, and liabiilties
Ofthe Palties: with respett m .acts or omssmns that: m:cur by either Pan::y poor to the
date Of e:rtpirationi or termination of this Cammon Agreement shall! SIH'\rlive sud!
expiratim'I «.termiination. •Fmlm.lii~ any ,9Piration or termination of this Common
Agreement,. the Paltie.s shall! thereafter cooperate :Mty and wort diligently in good
faith to atihie.Ye· an ordel1y radutio1t of all rmrttet!i resulting from .!il.lClli e;ipi1ratm or
temiiMtion.
19..UU The mHow~ sections .shal sW'W'lte. etpiJ:'ill'tion or termination of this
Common Agreement as more specfficillty provided befov;:
(i)
The fm!OWq sectkmts shlill .suN'i\Ve in perpetuity lfolkl'wiing the
expililtim'I or.termiinatim of this CommonA.lfeement: SeaJoos;
7.6 Umltatinn of l.iii1bility;; 19.2 Notices~ 1!U ·Gove:m~ig law,
ftlnll'll, altd .Jurisdiction; 1.!Ui Se,rerab'ilit:y; 19'.9 Independent
P•anies; 19.ltl Am of Cc11il:nlr:tm'S and A.gents; 19..11 Entire
Agreemen~ Waver; 19tl2 Effect o"f Agreement; l!U3 Primity;
and 19.15.Remer.lies Cumulative.
i(ii)
The ·I'm~ sections shall mrvwe fer a period m .!m( f&) ye.airs
following the expiriiltion or terminatillltl of this. Common
Ae,eeme11t:. s«tiicM 7.J. O::mftdential Information; 7.2 0iilsdnsure
of Confidential l111formatioo;.1.4..l Statement of General! Principle;
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ddrumheller on DSK120RN23PROD with NOTICES1
46
35154
Federal Register / Vol. 89, No. 85 / Wednesday, May 1, 2024 / Notices
~~~==~~Jra~~
~~=a~
•R .WIJNESSWHERBJF~the Parnes hereto} intending fegallytill:iebound lierel,r~have
~·-del~tffisCcimmonAgreement:asQf'thedilte-tirst:i!IIQvewtitten; •••
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ddrumheller on DSK120RN23PROD with NOTICES1
SigQature
Federal Register / Vol. 89, No. 85 / Wednesday, May 1, 2024 / Notices
35155
Exhibit1·totheCommon.Att;reementfarNationwide
H11:aalth·.·1t1~atian·.1ntel'Dpira1>iti\'
.~rt1•rit/S111~TenniQf Pa~i~11
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~enioni.o·
35156
Federal Register / Vol. 89, No. 85 / Wednesday, May 1, 2024 / Notices
Partiap1H1t/5ulbpart~arit l'e:rms ,DI Panidpatkm
lntn::id\ltboo:
Seaion .4000 of the 21st .C'enturY 0.lt5 Attdirect:ed the U.:S,. Depilirtment of Health and
Human Servkes {"HMS") Natianitlf Coonimtorfor Health tnforlmati,001 ledmotnu to, "in
collaboration with the National Institute of Sbndan:15 arid Technmogy and otheirrelevant
agencies .within th:e Qepa1rtment of Health and Human Senlites, for the ptJil'p0Se! of ensuring fl.Iii
n:etwon:-to-netwmk exchange of health information, convene pUblit·privale and pubk-publit
partnerships to build consenms: and develop or suppim a. t111.&ted scha~e fl'ilmewodl:.,
indwting a.. common agreement nong health informatim netwon:s nationally" (the "'Trusted
, ~ fRmewm and Cammm Agireementd' or TffCA$l!i'I). Tllte ,c,ommon agreement
referenced m the mregoing sentence is the Cbmmon Agreement. for Naffimwille Health
fil'lfotmaticm lmer:operat:l411ilt\l entered into by eaeh Qualified Health Information NetworkTM
("Qf!ltN•) ·that has been Designated to partidpate in TEFC\. The Cbmman Agreement
requires thiilt every QHIN a:mtrild!JaHy obligate their TEFCA Participants, who in rum are
required to mntl"iKt!Jally obti1ate their SUbpartidpants to comply with ·line
PartiicipantfSubpaniidpant Terms of P111titipati,0111 ("ToP";IUpstream QHIN, Participant~ or Subpa1rticipimt ("'OPS~). as idefilood belo.w, must en,ure.
that til1ese ToP are indw:led, directly or by reference; in a legil!lly elilfurceilbleconn.ct in wfikh
the Upstream QPS binds its .Partiidpants and Subpartidpant5. These ToP roost be: presented!
Md fflteled into WITHOUT !Bodim::etion. ~ thiilt Upstream QP.s Sim!Jjld insert its Mme in
the highlighted fieil~s) below and the, name of the QHIH if Ulpm,eam QPS is not a QHH\I and
may, but is not required to, add ggnaiNl'ie lines to the end of these iDP. For the avoidance of
doubt. til'le fufegmng is oot intended to pmhibi1: 1Jp$Ueam QPS from i m ~ additmnal terms
upon in Pandp1mnnd/or Subpartidpants, prolllided any such terms do not conflict with the
ToP with respect to TER:A IE.o:hange.
• •
•
Paniicipant/Subpariiidpant Terms. of Participation:
lNAJili; Of UPSDEAM QPSJ ("Up,SitfeUh QPS1 participates in TER:A bV P ~ I
te<!hnita! ard{or gc:Nemance se:mces to its Partitjpants and/or Subpa.niidpant.!i to oo1itate
their ability to ~age in TEfCA Exchange consistent with all applicable 1eea1 and mntl'ild:Uail
requiremems. [Ups~m QPS is aQHElif OR Upstream QPS. is,ai Pattidpantm Sutipanidpant of
{QHINj.J Yu orgamzation ("'You") wish.es to bemme a Partitipurt or Subpartidpant, as.
appie:abfe, of Upstream QPS so that You may participate in TEFCA &change.
As a Parooipant or Sul:!pa1rtidpilint, You agree ta abide by ·these ParticipantfSutipartidpalrt
Ter:ms of Partidpatim ("TOP")..
•
•
1. Definitions ainll Relev111n1 termioolQgy..
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49
Federal Register / Vol. 89, No. 85 / Wednesday, May 1, 2024 / Notices
.1.1
35157
Qelffled Jews Clapitalizied terms Hell in these ToP shall ha'll'e the meaning set forth
bebw. Where a. c:lefinitiol'li indUde.s m'lle or more citations to a statut:e, rqulattcm, or
standiln:t, the defil'ilillion mall be .interpreted to refer to :suth. sta.tute, regulation, or
standard as may be amended fi'om time•ta-am,e.
A ~ e law: all fe~ral, State, lco~ or nilbal laws and regulations then. in effect
and appl!iicable ta .the Nbi.ett matter berm. for the ilVllidance of doobt, federal
agencies are only sutijett to federal law.
Breldt •of U n e ~ tndividudy Identifiable tnmrmariim: the acqumti0111.,
acress, or Disdosure ofunem:rypted lndrvidumlt, Identifiable lrmmmrticm mainhined
bf an IAS Providerttlat cmrc>mmises the security « privacy of the unenaypt:ed
.lndMduillllly Identifiable :W'mmiltkm:..
•
•
Bu:smess Assodiate: has the· meaning assigned to .such tei"mi at ,45 CfR i 160.l!0,3.
Busmeiii .Assodiall:e AiJ"eemem: {BAAi: a •contract:,. agreement, or other a11aneement
that satisfies the implementa:tioo spedfications: described within 45 Cft ·§
164:.314(1) and ll:64.504{e),. a.s appllicabl:e.
C'oolmmi Ae,ee:m.ent: unless oithell'wise expressfy indicated, the Common
AgJftmenll: for Natim'IWide: Health lnfmmaticn lntemperabfflity, t.he: Wi~N Tedhnk:al
framewmk (QTFJ, alil StBndard Operating .Pmcedures (SOPs),. and illlll •Dther·
attachments, EJtlibitS, and artifacts incorporated therem t'.ly reference.
as
Conf"idem:ild fnformadoo: any inmrmation that ils: deslgnited Confidential.
lnkm:nation by the Ct Disdose~. ,ar that a reasonable pel'SOOI would Understaml to Ile
of a a:nmdentiat miture, and is disda!ied to a a Rledipient pursuant t0 a framework
Agreement. far the iMJidan"e of doubt, "'Confidential :Information"' dQes not
ilndlude eledl",onic prat«ted health immmaticm (ePHF),· a:!ii defin.ed herein, that i5
:subject to a Busilile:Ss. Associate Agreement and/or ,al!her prowsions of a fRmewotk
Agre.ement.
Notwtthstilndtlng: any label to the .ttllntlV'jl',. "Contidenda.l Information" does lie)t
indlude any information tha.t: (i) is or bemmes limown. publlidy thr~glil no t'ault of
the Cl Recipient; Olf (iii is learned by 'd\e Cl RedpienUmm a third party that the Cl
.lllecipient reasonably beli~ iis: ,entitled. to disdme it without 1restricticn; or (iii) is
already lmmtm to the a Recipient tlf!'ftft l'e£le'1f: from the C ·Distloser, as shown by
the Cl lb!dp.enfs wri:1:ten reconk; or (iv) is independently deirel!Oped ilV Cl ,Redpient
without the. use of or reference to the· Cl .lli:Sdoser'!i Confidential fnformatioo, as
!ihl:Jwn by the Cl Recipient's; written records, and WilS not sub.,iett to OJill'lfidentiiillitv
restriman!ii prior to reoeipt of sum information fir om the Cl Dm:lmer.
1
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so
35158
Federal Register / Vol. 89, No. 85 / Wednesday, May 1, 2024 / Notices
.•Coofidentillllnfonnadon[at.Oisdoser.e.pe~orentttytbat·disdoses.
confidential t ~ . ... .
..
. .. . . · ..
·. . .. . . .
~ I d lnfurmaliontq~a person orentitythatrece:ives tcritidential
•1mo~ .
··~~,:.~====:=~~~
.• and are comistentwifh.the requirements of the therHIIQilicable QHINTedtmtat • . •
.framework.
··~£mitj:hiisttiemeiin1q~dtoiiKhtemai1t45CFR§:l00.103, . .
Desie/natmNe.tvitlitt .ffie• Health lrifotmatimtNetwtri that a Qtmil usetto• offer and
pmvidettieOes:ipted Network Services...
ll~tedN~ G~Bbdy:a ~~andpalficijmolygroupot •
.·~Mi~v=~=~~~~~~:·•·
~•IEdNel\lfm'k·~·the~Sermlamf/orGovetrtance•
Sen!kes,'
··-~:==of~-==i:~.•
•ma~r>1.~:trdorrnation(TIJ~~-~boJdine;the·m~·
.·Di5ccwercindudingits~. . . .~~mid~ne-1:t11e
•· hffiiYon which something is knmmtn. ttie QH• Participant, or Slolbpartidpant,. «
··=':tt.~e~l~\HUfdhive~knOWl\.tothe•QHlN~Paltwpwnt:,
DimimimltoryMmmei:anactoramw.iiarithatisn:onsiStentDV'bl!km«hi>t·taken
with.respetttoi!Rf.iimilil!rtysttuatedQHIM. Partidpant;SUbpartitipan.t,·lndividuaf;
:==::~:=r«~:::::crhtia
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35159
.Be:Clrl:lak P,otected Heallli:h lnfmnutioo fe:Ail): has the meaning asspgned to such
term at4.5 Cl'R § l.60. lOJ_
&cha111ge Piurpose m IP'.: means the reason~ as a.Ultholize:d by a l'rame:wmlk
Agreemel'!lt, indudq the applicable SOPfs)~ for a t.ran.stnissiiM, Query, Use,,
OisdOSure, or R ~ transacted througti TEFCA &c:Jltanee.
Framework Agreemmt(s): with respect to QHINs, the.Cammon .P«reement; and
with respect to, a Participant or Sl.lbpaniidpant. tlhe TOIP.,
RC Ride the Health Breech Notifia,tmn Rufe promulgated by t!he: :federal Trade
tnmmiismn set fm1h at .Hi CFR .Pan 318.
GOYiernme:nt Bendts Determinetioo: iii i:le:terminatioo made by any agency,
instrumentality, or ot!he:r unit of the fede,ral,.State, local~ or tribal pemment as to
wtliether an ll'ldillidUilll ,qualifies fm" gmremment beneffls for any purpose ,other ·than
heailth care. !e.g., SiXial Security di!iiiilbilky benefilts) m the extent rper,mittEd by
,Applicllible I.aw. Dm:iosure ,D!f Tl for this purpose ml!;' require 11n alJl:hariizatmn that
complies 'll'l!lid, Applicable l.iiw.
Government Health tare En,tity:: any agency, iimffllmentalky,. or other unit of '!he
federal, State, liocal~ or triba! l(JVeimment to the elltent that it pf'O'lllides heillth care
services (e_g., treatment) to Individuals but onty w the extent 1hat it is not acting as
a Covered Entity.
6overnamie HRICtkms: the funcmms, actiw'lies,: and responsibilities of the
Designated Networt GovemBnce Body as set forth in an applicable SOP.
Govemamie S,emces:. the gpvemante funttions desaibed ,iln an iilpplic:able SOP,
whim are, pemmned b\l' a QHIN's Designated Network GtWefl'lance 8oo:V fer its
Pridpilflll and Sullpartidpants to facilitate JEl'CA E.ttbange in tmnpliance with. the
tlhe:11:;itpplicatile requirements of the framework Agreements~
Health Clire Provider:: meets. the definition of suc:il t~rm in either 45 Cfl. § 171.1(2'2
or mthe HIPAA Ruffel at 45 cm, § iSll:103.
Heahh lnfoonatioil; Netwodc [tiff,): has the mearing assigned to the tam "Health
Information Nerwork or Heall:l'l lnfonnaticm Exchange"' m the information ~
regulations at 45 CFR § 1.71.101.
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35160
Federal Register / Vol. 89, No. 85 / Wednesday, May 1, 2024 / Notices
HIPM:: the Health Insurance ,Portabillty n ,Amountibiit\l' Act Of 1996:,• Pub. Law
.104-191anr:I the Heillth lnformam::m Tedumlogy far Eo:lll'Klmk: and Cllinical Heelth Act
of 20001, Pub. law UHi
HIPAA Rules: the rregulations set fm:th at 45 CfR Pam 160, 162., and 164.
HIPM Prmcy lilule: the rquli!itiil::ms set forth at ,45 CfR Pam 160 and 164;, SUbpam
Aandl:.
HIPM Seairirf Rule: the reguka'lliicms set furth at 45 CfR Pan 160 and Pan: 164,.
:Subpirt C.
lmplemerlblllioo Date: the date si'ICtv (!50) calendar da,s after publication of version
2 of the Cammon Agreementm ·the Federal R~r.
l!ndmdtu11: has the meHine assigned to such term at 45 CFR § 111.202(,1)(2)~.
l!ndmdmil AaleSi Services tm:iderrt flAS l:nddftlt): ill TEfCA seairity 'Incident or ill
•Breach cf Unencrypted lm.ividuaHy ldentill&b!e ll'lfnrmiltion maintained by an IA:S
Pmwder.
tm.lmdl.tal Acce11 Service timsem: (IAS Consent): an IAS :Prolilider'.s l:IWl'I sulJPlited
form fur abtaini111 express written mns:ent.from the .11111::fimriduat in c:ooertion. with
the !AS.
lmfwidl.tal Alllless Senices Prmm:ler fllAS Pn:iwideirjl: each QHIN, Participant, and
Subpil!rtidpant that l:lffel'.5 l!ndMdual Aa:ess Sel\!iCl!.S (I.AS): ' '
l!ndwidl.tal AcceH Services ((AS): the selll'ices: provided to an 'lndividuilf by B QHtR,
P'ilifllidpant, or S ~ a n t that has ,a dired: mntractua1·re1atimshijp With sud!
llndNliduatl ill whim the O.iHIN, P~nt, or Subpartiqpant~ il5 aippUcibDe:, ,vees to
satisfy that lndividuaf.s ability to usie JEFCA &dlanee to access.,·11nspea;, obtain., or
trrainmlit a copy .of tha.t Individual's Required l!nfarmatim.
l!ndmdl.t11lly lidendiallfe Information~ informatioo thilt iidentifies an lndmd'lulal er
With respect to Whlth there ~ a reasonable basis tD believe that the Information
to1Jld be used to idemtify an l!ndmduaL
Initiating Node: a Node thr•'Olillh Which a QHIN, Partidpant, or Subpartiicipant
initiates trransattions fur IEFCA Exdu1nee and., to the e:xterllt such transanioo is a
Query. receives a ;Response to suc:h Query.
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35161
Node: a tedhnical s,stem mat is cootrollled dir'reoty or intlitealy by a QHIN,
Par1id,jpifflt:, or Subpartiidpant anti that is list.eel in the ACE D i ~ ' Service.
!Non-H!IPM IE1!11ily (NHlE): a QHIN, Participant, or S~artkipant that is neither a
Qnilered Entity nor a Business Associate a.s ,defined unde1rlthe HEPAA. Rules with
regard to attMties under a framework. Agreement To the extent a QHIN,
P.-tiidpillltt;. or Subpmti'GpiMt is a Hylmd entitY:, as defined m 4:5 CfR § 164..103, sl:Jldl'l
QHI.N; P,;mliipilm:, or S1.1-rtidpmt shall be Cml.liiderecf. i Nan-cHIPAA Entity ·wiitih
respect to TffCA EKttaqe a.ctivities related to such QHIN,. Par1idpam, or
SubpanidpiMt's; Mn-c!cwered components..
ORt: the U.S. ~artment of Health illlld Humin Serviw Officie of the Natiooial
Coon:lmat,ar for Health Information Technology.
Paniclpmt: to the extent perrit:ted by ,applitail:l&e SOP('sl, a I.ts.. Entity that has
entered into the niP in a le:galt, bindmg mrnratt ·with a Q.HIN to 111se the QHIN'.s
Designated Network Senlkes to parliidpilte in TEFCA Exc:ha111e in oomplmnce w'ffitb
theToP'.
lPafli::ipsn~ent Tams .of Parddipamm {JoP): the, requirements set forth
mExmblt 1 to me Cbmmoo :Agreement~ its reffected. ~ ; to whim: QHINs mmt:
contrartwlly Cllblipte tm!iiir Participants b:l, .agree; to which QH!Ns must CD"ltractmldiy.
obiigate their Pillltitq>ants to amtrart1.1ally ol:llipte their SUbpartidpants and
St.,bp~iiiints of th.e Sub participants to agree, in ordeirto participate in TEFCA
·w::'halnge im::Jud"g the. QHIN Tedrical framework (Qlf), ail a1pplkabl.e· Standard
Opeiratiing Procedures: (SOPs), anti all oth.er attaclhmenn, eit:hib~ and .artifacts
mcotparated therein by reference;
•
Privacy and .Sealm:y Nod.ai: an IAS Provider's: own supplied written privaqr and
seturiitV notice that contains the ii!omrmation required 1:1,r ·the applicable SOP(s);
Pmtedred Health Information IflltiJ: has the meaning illS&igne.d to silil:ih term at 45
CfR § 160..103~
Public Health Authority: hu the meillrlillg assiigned to sucih term at 45
cm §
164..501.
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QHIN l~ical framework (QJ'ft: the most recent effective ver:sim ofthe
t:IOCument that contaim the tei::hniical, fum:tiooai, prwacy, and sec11rity requiremerits
for lEFCA Exchallllt!.
35162
Federal Register / Vol. 89, No. 85 / Wednesday, May 1, 2024 / Notices
Qualified HealUI. krb'.mation Netwmll (QfllNt: to the 19.tent permitted by
applicable SOP(s), a Health lnfonnatioo N.etworll: that is a U.S. Entity that has been
Designated by the Rtt and is: a party 10 the Common Agreement count~ by
tine.ACE.
Ql.lety(i.est (ind!uding it:s co~tiwe IIRS/~ses ..Queried" mull ~ ~ ' } : : the
att of ask'irijt far mfor:madim 1lhrl:lll.tgh TEFCA. :Exclhii1111ge;
RtE Difectary Service: ii tedmial service provided by the :AC~ that enables QHINs to
identify.'l!heir Nodes to enal:!fe· TfftA· &mange, The requirements fm' UISe ,01~,
muskm m, and .maintenan.ce tlfthe RCE Directory Service ,iift!: set: forth mthe
framework Agreements, QTF, a111d,ii1pplicable SOPs.
leoolflrzed Coordma,tiq Entity'& (RCE™J: :tine enttty selected by ONC. that enter.s
mto the ((lfflffl.\t:1111 Agreement:witlh QHINs in l:l\tder to impose, at a mil'lim,um, the
requirements cf the Common Agreement, iindudi111g the SOPs,and the QTf, on the
QHiNs and administer such requirements on an 0111mng biltSis.
Jlequiried 11hfm'IMtion: tine Bettmnic:. Heaft!h lnfarmatioo, as defined m 45 .CfR ~
.111.102. that. i5 jl:) maintained. in a Respom.li111 Node 1:1\f any QHIN, P,iilil'tiapa1nt, or
~ t prier to or during the term ,of' the applicable Framework Agreei"l'lerlt
and {ii) relevant for a required i<P Coch!!·, iltS, set forth. in the QTf or ,an applicable.
SOP(s}.
Responding Nade: a. Node through Whith ·ttie QHIN, Paftidpal'lt,;, or Subparticlipant
,Rest>Ol'Jds; to a re~eilied transact.ion far' TfftA Exchange.
ftesponse(sf (l.ndudq in Wl'Jell!ltive usei/tms:es "'Responds,'" "'Respoinde.d" Ind
"Respooding"): the act of prwiding the inif'ori'mmo111 that is the subject of a. Query or
otherwise traris~ ,a memge in response to a Query thrOtlgh mCA :Emiange.
0
Stamlard •Operai,:ing Proi::edURfs) or SOP(s}: ii written procedure or other pn:msion
that is adapted pursuant to the Common Agre:eme111t and incorporated by refelrem:e
tlhe fram~ .Agreements to provide detailed inft:Jrmatit:1111 or requirements
mated to lEftA Exdliilng;e, mutli~ all amendments tlherem. Each SOP me.m:mes
the rele\lilnt group(s) to which the SOP applies. iincb.Kfing whether Participants or
:Subpartiidpants are required to mmply'With a gwen SOP.
no
State: any of the several States., the District of Columbia,.Puerto Roca, the Virgin
~am:11:s:, Guam, Amern:an Samoa., ,iffld the ·Northern Miiiriariil ksiands.
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35163
Subpartidpimt: to the 9tent permitted by appliic.alde SOP'(!s), a U.S. Entity that tliillS
entered mo the loP in a lelaily binding mntratt wiltih ii Partitipill'lt or another
S4Ji:lparliicpant to I.ISiE !the P'ilrtitipanrs er .S'!Jbpartidpant's CMne•ctMi't:y Serwces to
~ a t e in TEfCA &change in compliance wil:h the ToP.
TffCA Eldlange:: the tra111sartion of mfO!matioo. be1:wee.n Nade's using an '.l<P' Code.
·TEFCA fmormadoo (Tit: any morm.tttoo that is transacted diiroUe,h TEFCA Ell:d1ange
except to the extent thillt .mdr information is recewed tit a QJUN, Participant, or
SUbpill'ticipill'lt that is a Covered Entity, Business A$:sociilte, or NHE tl'llt i:s •eirempt•
from ccimpli~ with the Privacy section of the appfi[ajble.framevmrk.~ent:
and 15 ina>rpoiated into Stich recipient's syst,em of records,. at wh!dl point the
ilnfmmation is no longer TI With respect to sue.ti recipient ill!')d is, .govemed by ithe
HIP'M ll'Ul.es and. ,Olther Appkal:lde law..
•
TffC'A security tm:iderrQs):
(i) An unauthorized ilcqUisiti~ access, Disclosure. or Use of unencrypted Ti
usmg TEFCA &change; but. Nor induding any of the followint:.
(ii)
Any uniintentional acqoisffion, ila::eSs, Use., <1r •li'Jisdosttrie of Tl by a
Workfm"c:e Member ar person. ac:m,g under the authority of a
QHIN, P.ilirtilipant, or Silbpart.iqpiiflt, if sud! aa;uisltkm, acciess,
use. ,m- Dtscklsure O) was made mgood faith:, (il Wii!IS made by a
person ac1ing within their scope maud'lorttv, (ii) was made to
anotherWCrkfon:e :Memberorpemm attingunderthe authority
of ilffllV QHIN, Parlidpant, or Subpartqp•, and 1IM does not
result in further acqui.!sitioo, access, Use, or Disclosure, in ill millnner
net permitted under Appi:ileab31:! I.aw and the FRmewmt
Agreements;
(bl
A D&lo.wre. of n where ill QHIN, Participant, or Subjpillrtioipant has
a l)DOd l'aiith belief that an i.iMul:l'mlmed per.soo m wham the
Disdmiure w1s made wculd rtat reasonably have been able to·
R!tillm such inform1tiion..
,IC)
A D'isdarure ofU that ha.s been. de4dentified .in acmrdance With
the standard at: ,45 CFR :§ 164.514(ib).
(ii) Other seturi1y events (e.g., ransomw.are attacks), as; set forth in ani SOP, that
adversely ,illffect a QH!N's, Particijpant's, or Subpartiidpant's participation in
TI:fCA EJOC:hilnge.
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Threat Condition: (i) a breach of a mateitial pmviskln of a framework. Agreement:
tlhiit hills not .been mred within fifteen 1(15) day:s; of recehrq l"IIIJtice !Of the !'l'Nllterial
tlr'e~h 'f«. suc.lh other period. of time to Which the Partiiies hiin!e ~eedl,. whim notice
shalliindude such specific mformatioo aboot the ltm!ath that the 'RO: has aWli!al:Jile, at
35164
Federal Register / Vol. 89, No. 85 / Wednesday, May 1, 2024 / Notices
the time of U!e nom:e; or (ii) a TEftll Security Incident; or fiii) an ,event that Ra:, a:
QHIN, iits Particip,ant or their SubpamciPiJint has reason ro believe will disrupt
normal TEFCA Exchange, either due UI actual compromise of ,0f' the need to mltipte.
demonstrated 1t1Jlnerabiilities in .sy!ih!ms or •data of the Cl.HIN~ Participant~ or •
S~pil!l'l't, a.s aipplkd:de, or mukl be replicated in the S'f,Stems, netwof!ks,
.applications, or diiita of another QHflt., Pan:idPillnt. ,or Su'bpamdpant; or (i\!') any
event that OlUld pose a risk to the intere:Sts: of nmomil security as directed by an
agency ofthie IJ!'lited.St:ates p,vemment.
United States: tile fifty (50) States, U!e District .af OJlilmbia, and the territari1f!S, and
pmsessiDns of the United :States including. W:ittlowt limitation, aH mif.itafY bil!SleS •Dr.
at.her mlitary insti!illatii>n.s, embasme:, llil'lch:oosulms operated by the.United States
govemmeitt..
U.S. Entity/&tdties: any corp.oration, li\mited labiity • C i ~ ~ pal1nel'Ship,, or other
.legal ent:lq, that meets all of tile· following requirements:
(i) The entity i iS: organized under the larws of a Sltilte or mmmon.'l!IN:tt:h of tile
.United stmes or the federal lil!l\l'.of the United :s:t:at:es and is Sil.lbjert to the
jUrisdirion ofthe United States and the. Statie or ,commonwea:tt:h under
.
·wttkh it was formed;
Iii) The entity's prindllill place ,of businem;. as dletennined unaer.federail
mmnmn law; is in the United States;; aml
(iii) None of the emty'.s directors, iJHicei:s, or ieieecu!tives; and mme of tile owners
with a m,e percent .(~J greater iinter,est in the entity, are listed on the
.Spetiafly lJesignatedN~ and Blm::lial Pmo,ts· Ust· iPUblished by the
United States Department of the Tmsury's Offiire of Foreign Asset COl'ltn:II or
on tile United States Department of Healtti.am:I Human Se!Nices. Office of
lnspertor Gene~l!'slistojfltithJ,rJed ~ -
er
Use(st findluoing cm-relative ues:ttemes, Rlc:il u "llRI,"' ''Use.d," IUld "'Using"'):
with respect ton, means the shilring,, effliPlaymem; i!ipplicatimi, vtiization,
exaimil'lliftkm, or analysis of such mformatkln within an entity that maintains Sl.ld1
imormatioo.
Workforce Member{$): any employees,, volunteers, trainees, and Dther1permm
whose mooua., in the p,ert:mmam::e of wort foran entity, is.under the direct control
of such entity; 'whether or not they are paid by the entity.
XP Olide: the :cadJe, use,d to identify the XP in any gwen transiilttii>n, ,fi set fortlti in the
.applicable SOP(s).
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35165
Jut ldtmiOgjtgey
1.2.1 ~ s :m Yoo and OHINs. Partitipants, andl Subpartitjpilnts. As set forth
m its•defimtion and in the intnxluctory paragr.iph ar 1hes:e ToP, the term
"VOLi" is used ta, refer to 1he speofic entity that ij;; a party to 1he.se ToP with
the Upstreilm QPS. fl(oo and Upstream QPS mav also be, :referred to herein
mMdUally as a "Panv"' or QJHeciiW\elv as the "Pa.mes.") Anv am:tHlliffl rights
and obligations olf a QHEN, Participant: or Sillbparticipant stifled herein. il!l'e
binding Upcl'I all other QHINS, ,PillTtic~. and Silb:pa1rtidpants that h.we
entered into III Frilmework Agreement.. References herein.to "QHINs,"' ~:other
Pilll'tkiiparru,"' "'other Suti:participant!i;"' and similar sud! terms are UISed to
refer to any and all other' organizations lthlt: have signed a framewm'k
Agreement.
12..2 General Ruile olf cnnstruction. for ltlhe avaiclifflce of dooot, a reference to a
spedfic. sedioo of the ToP in a part«Jular sectioo does: not mean tlhat ottter
sectioos of the To? that. ellpressly appfy to .You are iniil!PPl~le. A reference
mthese Ttif'to ;my law, any reg!Aatmn, orto App!fkable Law indudes any
amendment,, modffi1Catioo or replacement to such law, regulation, or
Appiicable Law.
.U ... 91
Terms of Participation for SObparticipanrts. ·You shall contractually obi,eate
yoor S111bpartitipants, ihl'ltY; to comply wiff"I the ToP. Nctwi,'lhstanding 1he
~ Jor any entity that became Your Sub participant pricrtc ·the:
lmptementatioo Date, You .shall (ti cootractua.lly olbl!igate sud! entity to
comply With the 1:0P within OIU!'"flUndred eighty (180) dilys d the
'imptementatioo Date, provided that suth. sutiparticipant is and remams a
pm:ty to the Participsnt Subparticipant Agreement, as; defined in amt
required by Common Agreement Versicm u., during .such period; or fii)
ter1minate such entity's abiliity to engage mTEFCA Exichang,e upon the eider
of the date oftermination of the ,emtilQI Partidpant•sutlpartici~nt
Agreement,or one:-hum:fled (:l.80} days. a,fter the lmplementiilti°" Date.
z. t.ao,eiatioft end Nmt-Dimimmation,
2:.1
cm:p;;ratton. 'fma 11111derstant1 and admowtedge tlhat NJmerous activities \\lith
·respect to the ToP Will likely invol\le tile RCE,. QlflNs, and their n!SPective
Partiicipillnts am::I SUbp:artidpanrts, as Weill as e m ~ ilgmts; third-party
amtrartors~ vendors, or tonSIJltants of ead1 ,ofthern. ·vou shall rea:ml!ilbtf
cooperate, with the RCE., ONC; QHINs aru:I theiir respe:ctive Participants and
Sllll\partill:ipimtsi in aRI, matters related to TEFCA Exdli!lnee, indu.i:ling
disp1.11e
resolutioo actillities in Whk1h Y® are involved'. Expectations; fio~ reasonable
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aov
35166
Federal Register / Vol. 89, No. 85 / Wednesday, May 1, 2024 / Notices
cooperation are .set fmth iin an SOP. The mm Of coopeirati:m to Yoo !ihidl be borne
by Yo1.1 and shall! nm be chiltged to the 'RC: ,ar other QHINs. NO!thing il'I this 5ettion
2:.1 shall modify or replace the IEFCA Security !incident n0itikat:lion oblipltioos IJl'lder
Settion &3 and, if aptJticable, the fAS Incident l'Kltfficatioo obliiptiions. under Se:cliiol'I
6.:3.2 ohhe loP.
2~2
Noo-QiSmminatmn.
22:.1 Prohibition Against &::iusivilt.y. Upstream OPS shall.not prombit or attempt
to pl'tll"iiibit Yoo, oor shillll You or Upstream OPS prohitlit or attempt to •
prohibit any of Your Subp;:H1q>ants, if any, from jai11ing, exchangi11g with,
c o n ~ other transadms with, ;or supporting any other nel'llllOl'b or
ea:hange hmewmks thilt use· s;el\!ic:es. other :rmm the Upstream QPS's
DesigMted NetWQrt Services. or 'four Cormettivlty Seniia!s, <;onot11Te11dy
with Your or Yoor SUbpartitipal'!IU' pan:k~atiOn iin TEFCA. fmml"ij!le..
t,i(l1tWitmtandingthe foregor1111, th1iS subsecticm does not preclude Yl:11.1 from
·induding and enbdn,g rea!iiOl'llillble term limits i11.1he contratts with Your
s ~ relatedtoYourSubpardci'pants' use,Of 1tourCon~
Service!ii.
2.2.2
No Disciimmiliim Limits on Exchange; .of Tl.. ~ . You nor Upstream QPS.
shall eqag;e mTEFO\ &chan,ge,. refrain tn:nn1 eng;agq in IEFCA Exchange, or
Hmtt TEi:t.A &change wil\h any QHIN, Pil11:kipant, S•artici,pant;. or
lndMdual in a llimiminatcry Manner.. Nat\Wlhstanding the foregoing. if Yi:ru
t"d'rilin fi'om engqq in TEFCA Exmange er limit inten:iperabBiitY With any
0th.er QHI\N, Parltitipant, ,or SUbpartitipant um:lerthe folii<Mling
d!ra.lmiSil:ante!ii, \'011r aictions or iniKtiion!ii :shall na11: be deemed di.Sm1minatilry:
1(i) Your Qmnectivlty SeMce!ii req11ire load bllial'lldrlg ,af net.'WOlt traffic ,or
simiilar adwities provided such ,acti'llities are implemented in a 1:c0nsistentnnd
noo.~disi:linnat:IJirY mianner.fllr a period onime no tonger than necesgr, to
a.ddres: ·the netw011:: traffic: is.sue; W) l/:OU haw: a reasonable .amf gomHaiilth
betiief that the other QHU4, Pilrltitipant, ,or S:Ubpartidpant has nat misled or
wil nm be able m Silltmy the applicable terms Of ill framework Agreement
•(indudq mmpliance. ·W!i\th Applicable Lav,). many material respect;. and/or
,fiii) V•oor attioos or inattioos awe a:insment with 0:r permitted~ an
appica~e SOP. One QHltN~ Partidpa111:, or Siubparticipant sl.l!iipentling its
othange•attiviities. with anall:her QHIN, Partmpa.nt, or S11bpanidpant.in
aooordance·~ Section 17.4.2. Of the 1CDmmonAg;reementorSetti01'11 lll'1:.S
of the TDP, il!i applkablle, !iihall Mt be deemed diStlilffll'lliltmy.
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2. 2.3 Updjptes to Coonettiw:ty Sen.nas.. 'In 1revising and updating Conneaiwlty
Servk'es,fn:im, time m tiime; Yoo Will use commen:ialtiy reasonab4e effml:s to
Federal Register / Vol. 89, No. 85 / Wednesday, May 1, 2024 / Notices
35167
do so in at.cardilnce wi.th generally KCepted inc:lustry practices ill'ld to
aimplemem. any cha111,ees in a noo-disaimina:ltDl'y mal'!ne1'.: provided, h0We'l1w,
this pn:Rlimmshllif 111ot apply to lifllit mcdffilOdions m- updates to ·the e:lliteffl:
that suc:11 revisiions or updates are required by Appkable Law or
•
implemented tio respond promptly.to newly ,dismvered 1pnwcy ar security
threiilts.
.2.1..'1. Notice of Updates to C011na:tiyity Senm:es. Y:au shill implement a reporting
prottl0:11 to pravirie reasonable prior writl::eri ootice of am modifDtimu: or
updates ol'Yoor Qmnectillity Serviltes to Upstream QPS and Your
Sullpiilil1idpants if such re!rim:ms or 11J.f)iiate.s are ,expected to adversely ,ilffecl:
Yoor iillbilhy to engage 1111 TEFCA E11dlar.:e or require clliHlleS intlle
0:lmectMt\f Sleirvices of Upstream QPS or Your SUbpilrtidpanu, regardless at
whether tlhev are necessary due to Appliallbie law ar ne'Wly discovered
pliwcy onemrity threats.
•
•
VerDate Sep<11>2014
:3.1
Q:mfiden!@I tnifonnatign. Yoo and Upstream QPS: ·MC'h ile:ree to use and dimmie all
Q:mfidential Tnifoffl"latiion receililed pursuant ·to these ToP only as a11.1tlmrized i111 these
•ToP and any appliciillble SOfills) and mtety tw the purposes of 1perlfor1mng its
obligations under a. framework Agreement or the proper e:liichange of infofflliltmn.
t!hl"ffl.l\eh TEFCA &l::hiill"lge and ·ft!r oo other purpose. YIIN and Upstream QPS may act
as a Cl lilisdoser .md a Ct .9.etipient, arccrdirlgfy.. A Cl Recipient may disclose the··.
Ctlnfidential h11li:mna:,tiioo it rec.ewes anly to \Is. Warkfi:>rce Members wtlO require
suc:11 llmowledge and use in the: mtlinilflf ,coLll'Se Del scope ohheir effllP}oyrhe1111t: or
retention.and. are obf~te:d 'to protecUhe mnfide:rit:rality of1he Cl Disc11o.s:ets
Q:mfiden'liial Jnlforma:lliion !in a .manner substantially equivalent to the terms required
herein fur the treat"ment c,f Confiden'liial• lnlfmmatim. If a a Rec"ient must disdose
~e Cl Discloser's toofidential lnfarmiltioo u!"lder operati® nf law, it may· do so
pnli'llided 1hat, to.the extent permitted by Applicable Law, the Ci Recilipient· gives the.
Cl Disc1J(>Sef reasonil:ble notice to alow tbe Cl OisQoser to ol:Jject: to mcl\l
redisdOSll.lre, and. sucJh rreclisdasure is made to the miinii'mHn e:tt.ent neceSSilll"y tc
comply wim Applicable Law.
3.2
Disclosure of CO'nfidel'lt.iilit lnfmmatian. Nothing hereilli .mall! be interpreted to
pld'iibit Upstream QPS or the '.ICE from discl'ning 11'1'\! Confidentiall ll'lfurmmoo tu
ONt. You ild:nlJwlledge that ONC~ is a federal g:ovemmenitagency, is subject: to the
freedom of lnformmtim•Acl Any diisdosure of.Your confidential llrlftlrmation to
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3:. Coof"Nlentid/ity and AalOOlnblbiity.
35168
Federal Register / Vol. 89, No. 85 / Wednesday, May 1, 2024 / Notices
ONC or aflli ONC mntract:or Will be !illb}ect to Applimbfe LiW:, illS W'ell iS the
liimiitatiOM, proc,edures, a:mi' otf'lier· rele'lliJJM i::mwim:lns of any a,pplnble SOP(sl
3.3
ONC'.s and the Ref's Agpmacll When Rgguesting Oanfidem:ial lrlformatian. ..Ii& a
.matter of eeneral pmiqr,, ONC: ml •request only ·the limiited set of Oanliiidem:ial
Infimnattoo that ONC believes is necessary to infanm the .specific facts and
.
drrom:stances ofa matter. The RCE ·mal A!!l.}UesI1:sontf the limited set ,of Confldential
1\nfil:111:nation •tl'iiat the RCE belriies is necemry to intomt the spemic facts 1ild
drcllm:stances of a miitter.
ii. ICE DirectOJY Semce and Qirectory fntries.
4.1
Utilimipn gt' •Directgry Entries... The• A.CE Oiirettory Servke.1nd Direamy Entries
conitilied. therein shall be used by QHINs !!itiaely as necesyry to create and mlimaiin
.operational connedivlty to enable TEFCA &mange.. Upstream QPS is p!"Ollid~ Yoo
with .access to,, amUhe rigllt to use, Directory Entries ,oo the e,ipress ammtmn. that
You only we and diS(:llose Directory Entry information as nec:essary to advance the
mtel'lded 1J1Se mthe Directory Entries Df as required bV Applicable law.. for Siffllpie;
You are: permitted to disdme Dimctory fmry information to Your Wortforce
Members, Vour Subpilll!ticiipint's Wcmifome Members, ardjor to 1he Woffl:fcrce
Member.s of heall•'llh mnformation tec:tmology \l\eOdl:6 who are engaged in misting
Yoo or Your Subparticipilnt with establishing anct maim::aining mnnectiwty via the
framework Agreements. flll1:her; You shall not use anather QPS"s mrectlHl' Entries
or iiinmrmation dlerwed therefmm for marke:'ling or anv form at promotion of Your
owin pn:muc:ts arid semces, uniless otherwise permitted pursuan1: to an SOP.. tri n.o.
evmt sbali1 Yoo use or ,dooose the inforimtmn contmned iin the Directory Entries in
a manner that sl"IOuld be reamnably expe,aed to have ,ii deu'hental .effect oo om:,
the RC~ Upstre.ar11 QIIS., Your Subpartidpants,. other Q}UNs, ,allhelr Participants, other
Sutipridpants; Of any other individual organization. for 1lhe .avoidance of d~.
mriect:my EntneS, .are confidential Information of't1he Cl Dt!ildoser except to me
extent such information meets one of llhe Ei!xteptimls to the defiritim'I of
Ccnfidential Jnt'rm:matioo. Nathing herein .sllali1 be interpre:tied to prohibit a QtHN or
Upstream QP.S fn:lm publicty disdm.irlg llhe identity of its •!:Wm. Partkipitntlii or
Stqlill!tidpants.
or
4.2
:§.
ToP ,Reaffll. YO!U mus.tmaintain ii record of afl ToPs into 'whiid'I Yoo enter with Your
Subp11111idipants, if any~ rep1rdless. of \Vhetller slllth S\lbparttapams are lii:Sted in the
RCE Directory setvices. Such record must be provided to the. RCE within fnur (4)
business dafS fOlowmg the RCE':s er IJps;l:ream QPS's writt,en. Irequest ,unless suelh
other timeframe is agtteed to by llhe RCE,
T:fftA &dtange.Acdvitie-5,.
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61
Federal Register / Vol. 89, No. 85 / Wednesday, May 1, 2024 / Notices
S.l
35169
Utililaticm of TEfCA, E'mlanee. Yotl may ffl'llly utile Connettilri,ty 5eM'C.'eS for
puq:ice Dlf facilitating ma. &dltange. Yoo may only utiliize TEFCA, Eltmanee fer an
XP. To the e::«em there a1rre: limiiltation.s: oo wtmn:ypes ol' Participants or
SUbpivtil(iipann ffli'l/tRtnSiillrt.lEFCA lnformationfm' ii speofic.XP, .wch limitations
wil be set forth i!n the applicable SOP(s). Afil 1EFCA Emunge is gow:med by and.
must :compiy 'Wi,th tl'le 'frarri,ework Agreements govemiing the QHtNs:, Pamtil'«lltt\
•
•
and Su~articipants engaling in the TEfCA Em!ange.
VerDate Sep<11>2014
Si.2:
Uses. You may Use, TI in 1ny manner that: PJ iS not pl'it:ll!il:lited by Applitilbie Law; (ii)
il5 consistent with Your Prilvacy· iind Serurily Notice., if illRJlicable; and .(iil is in.
accordance w¥ih Sectians 1.and I of these ToP.
Si.3
Disdosure:s. You may Dis:dme ll pn:wided sudh DiSlC!osure: l~) ils not prohibited by
Applicable Lilw:; (ii) is ro1nsisten1: ut1h Your Priliacy and Security Nmite, ifapplkable:;
and (iii} is in ilCCordlance 'Widl Sections; 1 and 8 of these 1:oP.
•
s ..4
lilesppnses. •E.:looept as ,otherwise: set forth in an ap,pliicable, .so,.. Your ,lileS'iptfflding
Nodes: mmt Aapood to. Queries mt all XP. Codes that are identified as '"reqwred;" in
ee appbble SOP{s). SUctl Response. m11st mdude'al.l Required lnf'itlrmatioln.
NO'l:Wit:hStamfrng the fo~iq, You maiy withhold .5ffl'fle or all of the Rle.quired.
lnform111tion to the extent necesgiry to comply with Applicabl.e law.
S.:S
Spegal •i:,gl RegUirements. If iill'ld to me ment Apptitable law r,equires 1:lilirt an
llndMdual either mnsent to, appr,m,e,. M provide an ,illlJthoriHtim'I tor the Use or
Disldlmure of tl'lat lmlhrklual''s in.farmilltion to Yw, sum ,as a mm-e .stringent federal
or State law retati~ m .sensithre health illformaticrl.;, then You shalll refrain fn:im me
Use or Disdmure of such inhmiltian ifl CDl'lOE!!Ctiion ·witJh these: loP unless such
llndMdual's consent apprmial, ,or autlmriz;atim1 has been obtained ummtent 'Widl
me requirements of Appliitable· Law and SldliDn 7 of these TDP., including, 'Wlilthout:
•1iimita1ion.. commul'litated pursuant t:o the access consent: potie:y(ies) described in the
QTf or a:pplicatlle SOP(sj. Cll)pies of such 0Jn.Se11t~ apprOlililll~ or authariz.aticn smU ·be'
maintained and transmitted pUrsuant to the process desaibed in. the QTf by
'lllhidlarer party is required to llbtam It under Applicable la,w~ and Yoo fflii'\i' make
such copies of the t.tlil'I.Serlt, a:pprwal, or ainoonzatkm a!l.iliabl.e ele:ctm111icaily to an,
QHIN, Partkiipant, or Sub\J]articipant. i!n acmrdam:e, with the QTF and toitbe extent:
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To the eKtent that Upstream QPS provides: yoo 'Mith acceu lio od:ler heddl
inf:mmatiioa eJCd'lange networks, these ToP do nm aff.ect tlhese orrher ai:tirit'ies or
tlle l'.e.lilSIMl'ls fol W'hidl. You Mlll'f request and e1change in.formation !il!llbin diiese
otba nebJwillwllf., Sud! iM:1iwides ,1H1!, riot m ilH'IY way ·imited by tlhe Framework
""eemmts prmrmed the ttansacllioos are not TEFCA Elchange.
35170
Federal Register / Vol. 89, No. 85 / Wednesday, May 1, 2024 / Notices
permiitte.d by Applk,ab&e I.aw. Yoo shiilli mamt.ain written polities and proc:edures to
allow an ll'ldwidual tel 1revolll.e :sudl consent, approyal, or a,uthomation oo a
prospective basis.. If You are .;m liAS Provider; the fciregDine SM'lf not be interpreted
to mdfy, replace, or mmmis.h the requirements setfmth in section 6•ofthese ToP
al'ld any appliicable SOPIS) for ootai'l1iilng H• lndividuafs express written consent.
VerDate Sep<11>2014
6.1
!AS Of!fenng(sl. Yoo may eil«I: to be an IAS Prmrider by offering I.AS to ifllll' llmf~
in aa:on:lance with the requirenlents Oil' this section am! in aa:ordance with ail C'ther
pmvisim& of these Taf' and appliialbte SOPits). Ncthing: in. this Setitimi 6 shill modify,
terminate:, ar in .any way affect an lndwiduah right ct actess under the H,IMA
PlTl.l'ilC\I Rlule at.45 CF!i. §: 164.524 H You .are a Covered Entity or a Busiine:ss Associ:ate.
Nothing in this Seman 6 Oil' these Tol?I shall be amstrued as modiifviilng or t:aq •
precedence mer any provision adfied in 45 Cflt P,art HL An IAS<Pmwdershiilll not
prohibit er attempttoprooibltany llldiwdual IJSingthe 'fAS Dfany miter IAS Plrovider
or fram joining, en:hillnging With, coodw:tiilg other traMactions With any other
networts •ct 8Changeframeworts, using servmothelr than the Wi ~ •
Designated Network 5ervice~ mnmrrentfy mth the QHIN's. Participant's; or
Stlbpanicipant:'s participation in TffCA &mange;
6.2
lrldhliduilll Consent. This .settron 6.2 shall apply to You iif You are an IAS 'Provider.
The ll'ldivi.dual requesting lAS .shall be responsible for completing the I.AS Coosel'.lt.
Thie IAS Consent shaHind11Jde, at a minimLffl'I: (il consent to use the IAS; (ii)the
lrldivk:luaf's acknowiedgement and agreement. to. Yoor ;Plivac\l' and Secu11ity Rotite:;
and (iii! a dlesttiipoo111 of the Individual's rightt to iittess; delete, and export such •
lrldMdual's: lnamdmiffly klentifiable llnformiltioo. Yoo may ,implemenll'. secure
electro111ic means {e.g., seoure e-mail:, .seoore web pmtal) by wl'lich an lndiwdual may
subminhe IAS eon.sent. Yoo shill coHect the IAS Consent prior to the '.llndiviiduat's
first use oftbe lAS 11nd prior to any subsequent 1use if there is any material mange in
the appliical:llle IASCoosent, indudingtheversmn.ofthe .Prwacy ancl security NMice
;reft!renc:ed therein. Nothing in the IAS Consent mQ tontradict or be il"IICIClnsistent
with .any applicable prwisioo of these ToP or the· SOPi(s). If You are a Covered Entity
and have a NMice· of ll'rilllaqr Pratltkes thm meets.the requirements ,cf 45 CFR. §i
164.520, Yoo • nm: requi:red t.o hi1111ea Privacy and security Notkie thilt meel:Si the
l"leqUirementS of the .appicable SOIP.. Nothing iin.Sectiml 6 tedias ii Co¥ered fm:lty'S
obligatmns under the HIPAA R.ules..
••
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6.. .lndMd1.u1I Aooets Servmes.
35171
Federal Register / Vol. 89, No. 85 / Wednesday, May 1, 2024 / Notices
63
Addjtiftlst:s;urifyBCAJlim)mtsBtN~·•·•. ·•lta~torn~.tbe
Vour11ust~~i-he~~ohh1s~e@!Jri. •• • • • • ••
-~si!QJiitV~re~setforthln!iietmrttt. ifJo1uirearilAS~ii:ler,
ill
·Smpe;.Dfi;cum.y Requirements. Youmushneetffie~prjitiltiiesei:urlty
.~.2tf'cirth•.•m·Sediort•atnr•11·~~·~
~ycii,·~·as
...iAS.e~~~oi~.slitii
'5U
•
•
•.•
~
6:3.2 0$1nddent~ mAffeqt',dlndivitfuals_ . • lfJ~~lf llefievethatan
~~~•J~tJJanll.Sl~'[Oll111•~.Slleh••
~.'Mtb~~~--yantfirttlotase~.
~·siitvC60J···diijs.·ftll1.ine·~oi•~·JAS1~. ·lJie~li
•~nid•tmdel"tiais·~.·n1t1st•.1n!•.~111JJ1•1a~aitds11a1t•·
fftdude;1ot11e~ . .1de~•111eirdmb1ilfittn·se1:mtlhmttte~e
SO,CS).Tothe·e1.1mt.JouarealreadyreqlliredbyApplrQb\etawtonotny
anindivi~m1uii~that•lllll~ bc!:iffl.~ ~ this section.
.does·ootrequite·•~~m.1o.1hilt•tridividuat
&.4·•
~1-~~"fhlS"~n._•~~~tovetl~Y~~a•~
~r-, ..As~'toua$a~.MSPRMCierna~tttelASfl'Dlllider's
~·.i1lt11e•JJ\S·~•irkludii,eYour~totllmpiy.·wi11ihe
.f!ii.iaty.and.Security~ .nlprovfflel~Piill$ftb·~··shal[~f(Jrso
··tdiga$tou•-intiiiri~~si~1~l:lle.1raikmiirio,1c 1tvou
.~.·ar,;~~ifler~~~~~of~i&S~•~~~~or
-TaPmrioiongas'foll mail&in.individualyldentifial:lle:~ ~
•.dun111ftiterin,o1111esetoPasariJASP~rregardiesstlf\lfll~sucl.
•
•.•infan-niiltian l!ii•Qrwas lt
1..1
Compfiilm:ewithttelffPMPrwiilty;Rule/ffl'cuarea·NHE1,11utnottotheextem
~loua~actin£i1$an~~'.l0Dlil~t1~e~Benefit5
Determinatitmunder~l.aw,.aPilblidfeiiltbAutborily,.or.aG&Mntnent
·~llh•¢ate.~~.«it.•~··~•·~.o1~~~•·~i,Jiantj!~•
~·.man~eSDPt~·Ymi••shalt~••·ihe•·~KlflSOf.ihe
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·tt1fM~•~e•~••~·~.~•'tl>·~1~0jli!~tile.
35172
Federal Register / Vol. 89, No. 85 / Wednesday, May 1, 2024 / Notices
iinfarmatian as i:f sUldi informatian is Protected Heaitth Information am:I You are· a
•Covered Em:ity.
7.U :From 45 CfR t 164.502. General Rules:
•
Sul:Dertion {a)(l:)- Deillling With permitted .Uses; and Distlmure~. but
,only to ttie extent You ilf,e Mrthorized1. to engage in die activities
described in this subsec:tmn o f . , HIP.AA Privacy· Rlule for the
,111pplbbl,e XP.
• Sll.ltue.cticm (a)G2:J(il -Reqwnng DiSdmures to l~als
1...1c2
•
Sub5ection (a)(SI - llealli.ng With prohibited U.ses am:I Disclosures
•
Slt.il.section (bJ- Deaing_!Nith the mil'limum l\eeeSSiry' .standiHd
•
Sub.sec:tKlln {c'I - Dealmg W'iid'I agreed~upoo :restrictions
•
.Sltlb.sec:tion (dl - lleaing with de-ident:ificiltcm and ~ffiultmn of
.information
•
Siubsec:tKlln (el- Dealing 'Wiith Busmess: Assooat:e: ,ll:lflitrac:ts
•
Subsection lfli- Deill1n1 with dereased petslffl5' inmrmmon
•
lilibsection
•
Subfflttion (hJ- Dealing with tonfKleRtial communitatioris
•
Slt.ilsection {i)- Dea:4ing with Uses .and Disdawres consistent with
notice
•
Siubsec:tKlln 0)- Dealing with Disdosures by whimeblowers
oo - Dealing with persoriial representatNS
45 CfB § lff sooe1 AruoizilJigna1 Be1YiRroi::®i,
7.1.3 45 CFR § :lf54.508 ..Authmil!iittiml R,equirect 'Notwithmindii'lg the· foregoing,
the pR:l'olisions of SectiDrllS: 6.2. :shall comr101 and this Section 7.'.1..3 :shaH not
a~Iy with respect m 'loo if You are an IAS Provider that is a -NH£_
1.1.4 4.5 cm§ Ul4.510. uses and Di15d05Uf5; Requiring Oppmtunity toA@:ee or
~ - Natwitllstanding the foregoing, an RAS Provider that is a NHE but its
not a Health care Pn:Jvm .shall not hiWe the right to make· the permissive
Oisdos111res: described in § 164.51Q[a){3) • Emergency drrumstances,
pl'Olliided, however, that an 'iAS Proivider is not pmhi!blted from making such a
Diwmure If the Individual has o:.msented to the Disdmure pursuant to
Section Iii ,of these To?. .
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7..LSi 45 OFR t 164.Sg Authotizatioo or Oppgrt.ynit.y tu Otliect Not Required.
,.otWithSbnding the foff!IOing, an IAS Prmlidefthat i.s a. NHE but i5 not a
Federal Register / Vol. 89, No. 85 / Wednesday, May 1, 2024 / Notices
35173
Healttl care Pl'OVlider shall ·.not hilllle the ~ht io mate the permiS:swe
Disclosures i::lle$cribed in §.164.512(c) ~ Standard: Disdcm1res aboll.lt victims Of
abuse, neglect ,or domestic violence, § 164.Sll Subsecti:on (d) - Standard:
Uses and Disclosures mrlhealth. - ~ acthrities,. and§ 1.64.51.2. S!ilbsertion
.{i) - Standard: Uses and Disdmures to avert a serious threat to health or
safety; provided, hO'ltteRr, 'dliillt an lAS Pi'icMder is not. pro'hilitied from ma'ldng
such a Di!Sdmure(sl if the lmfNidllill has ,oon:sented to the Disdomre[s)
pursuant t:o Sectmn. lli or 'llheSe TDP.
7.1.6
from 45Cf,it
Disdosures:
t 164::5l4, Other Requirements Rel·atingto uses and
•
Subsections 1laHc)- Dealing with de-idel'ltificatmn requilrements that
11im:ier infar:matioo not lndiwidually identifiable, lnfiDrmatmn for
purposes of this Section 7 and TEfCA Security Incidents
• Subsection ldJ _; Dealing with. minimliim necesury requirements
• Slt.d:l:section (e)-- Dealmg ·W'iJth Umiited Datil Sets
1.1.1 •45 cm § lli4.5.ll. Rights to Request Privacy Prot&tmns,
7.J. .JI 45 CfR § 164.524. Aa:ess orlmlwidi.als. exc:epUlmt an IAS Provider that is a
NHE shall be subjett to the requirements of Section. 6 widt respect to access
!by Individuals f:Dr pi.arpb!i,es Of !AS and net this: Secl:km 7.l.B.
1.U 4.5 CfR i 164.5.28; Atmuritmg m Disdas:ures.:
7.1.10 .from 45 CfR.:§ 164531}, Admini:strative Requirements:
• Sl:lbsection {a)- Dealing with pem:mnei de.ations
• Subsection (lbJ- Deaing with 'llr:illiniing_
• Subsection ltl- Dei!lmg ·Mttl safeguards
• Subsection (d} - Deaing with a:implaiinU:
•
s,Ld:l:section (e}-Dei!lmg wJllh unctioos
•
Subs&tiOl'I (f)- Dealing with mitigiltim
• Subsection (g) - Dealing with refraining ft.om intlimidating ar retaliatory
,acts
•
Slu!bsection (lhf- Deaq with waiver ,of 1i'ights
•
Slubsection. (i) - Dealing with potmes and procedures.
• Subsiection W- Dealing with documentation
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35174
Federal Register / Vol. 89, No. 85 / Wednesday, May 1, 2024 / Notices
7.1.
Written P'rillaty Polley. You must de'll'elop, implement; make. p.ibHc~ ,illl\i\lilati,e, anti
act: in accordance with a \Witten privacy p,oiq· describing Vcur privacy pra.ctiites with
respect to llndMduiihl.lly Identifiable linft.lrmiatioo diralt: is Used or Dm:llamd purs1.1:ant to
these Toi". Yau om satisfy the !Nritten privacy polity requirement iby im:11:ning
appkal:llle coment consistent with the HIPM Ruies il'i Y:crur e:lfi>sting privacy p,olicy~
except as DilheMise stated 1,erein with respect ui IAS Pmwoers. If You are. a
Covered Entity, this written pdvKJ policy requirement does.not suJllplant the HIPAA
Pmr:ac:y R:ule dtriigarmns t'1• post and diS'lrlnn::e a Notiti! ,af f'ri'IIIKY Practices that
mieelt5 the rieq1.1irements of45 CfR § .164•.520. ffY,cu are a Covered Emily, then this
Vlfl'it!len PfWilCY .pdicv requirement can be .s.il'lisfted by Your Natice· of 'fil'iviH:¥'
:Practices. tfVou are an tAS Provider, thenthewritten pnyacy~ requirement
must be in the form of a .flm,acy and Security Natice that meets the requirements of
Section 6.2 ,llf these ToP.. Hotwlthstandq .section 1U,, to the extent the Signat,mys
written privacy policy is ·"more· stringent" than thie HIPM Priw,iil!ty Rule proviSil:ms •
lilned below; the Written privacy policy shall govern. ..More stringent" shall have the
meanine: assigned to it in 45 CF:R § 160202 eJteplt:the ·written privacy policy shall be
substiituted for references to State law and the reference to "standant.., .
requirements or implem~icm .specffionmns adopm:I under mbp,Brt E of pan 164
of this SiUbchapter" shiill be limitied to t!hose listed below.
•
•
8. security.
:IU
SeS!:!fittCi>ntn>IL Yoo .shalt implement and maiintain il!ppropliate security cootroils
for lndMduaHy h:lentffiable Information that are ccmmensurate wltlh 1rl!sks to the
mnfidenti,ali:ty, integriity,. and/or BYailabiity of the lmividually lden'iimble
fnformation. If 'l'm.i are a NiHE., You shaH <:D11i1Jly Mth the HIPM 5ecurity Rule
promions with respect to aH individually ldermfidllle lnformatioo as if sum
ilnformiirtioo ·were Protected Health lnformatiM and Yoo were a ta.iered fntity •IH'
Bmiiness Associate. You mall tm,t1piy with an, additional security requirements thit
may be :set forth in an SOP. iippllital:ile. to Participants and SU~rtkipanu.
1.2
TEFCA Secum:y ~nddent Bm9rting.
8.l.1
Hc::PmJllg mYmmam AP:$. Yoo shall report to Upsltream QPS any
suspeaed TEFCA :5eturiitY Incident, as set ifiolth in the applicable SOP(s).. Sudh
report nu11St indude sufficient. mformatioo fllr Upstream QPS, am others
a ~ to understand the natureand. lii!krety .srope of the TEFCA. Serurity
!Incident.. You shilH supplement the· mklrmation contained in the report
additional relevant information become.Si available and cooperate witb
·UJ:11S'trieilffl OPS and,. at: the direttil:m of Upstream QPS, ·wi:1:1, the Atf, and With
as
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67
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Federal Register / Vol. 89, No. 85 / Wednesday, May 1, 2024 / Notices
16:59 Apr 30, 2024
"t· i
35175
EN01MY24.117</GPH>
35176
Federal Register / Vol. 89, No. 85 / Wednesday, May 1, 2024 / Notices
applicable to Yoo. It iis Your responsiitility to .det•eimine, in consultation wllth
•Upstream 1QPS, which of the SOPS and QJF provisions are app!iciiible to• Jou.
9..2
Your Respansibiltib for Your Sul:!partiidpillnts. Yoo shall be respcnsib&e fDrtiiking
reasooaible steps to col'llfirm that ~t of Ym.ir Sitlbpartidpants (;if ;my) are: abiding by
the ToP, :specificaily mdul:llng all apptiialble SOPs if'id QTF provismns.. In the e\.ilent
U1ilt You become aware of a material rimt-mmpliance by me of Your
S!Jbpiirticiipar'lbi, then Yoo :shall pmmpt.111 notify the Subpanicipant iln writing:. Slid!
notice shall il'lfbrm the Subpartiicipant that its faili.lre to correct any wm de&:iiienties
wi~ thirty (30) di!YS of receiving notice shall constitute a material bread! ol' the
ToP., which fflitY· rewltiin early termination •of these TQP.
9..:3
•Joor Respanstilky {gr YR Third-Pany Tedln.olop Vendors. To the extent that You
use a thiRl~pany technllklff vendor that: wiH have iillOOe5li to nfCA ll'lfmmation in
mnnecm:in With a:mneeitNi/ty services •Of TfFCA Extha1,ve. You !i:llal indtlde iin a
written agreement with each sueh subc•ootrattor •Dr agent a requirement to u:impty
with 1111 applicable pi:misions afttee loP iffld a prohilbitim on engaging in any act •
or omission. that W'DU&cl cause Yoo n:rviolate the terms ofttlese ToP if You had
~ged iii well act or omission Yoorself.
.9.4
fees Charged bv; QHINs. Participants. or Suooaniammts. You may charge fees to an
llnitiating Node when ! l e . ~ to Queriles, through TffCA Exchange iiliS defmed in
an applicable SOP.. The ~ shaH not prohibit You fnlm charging Joor
S~<ilpiffltS fees for use .Df Your 0:JmettMty Se~s.
VerDate Sep<11>2014
10.l
Term. "Jhese· To? shaBI l::lerome .effective ~cm ~ e n t of both •~niesand .shalt
remain in effiect until termimrted. by either Party; Yoo maytenniinate these ToP by
plmlid~ at least ttiirtv (!ffl~ days' prior written nottce of teffl'lll1iltim to Upsitream
QPS. Upmeam QPS may t:emiiinilre these ToP by prmiiding at least ninety f.90.1 darys'
poor lli!ritterl ootite to You. N~nding:the fo~ing, in the event that
Upstream QPS's Framework Agreement is terminated, Ymir ToP sham. be
immediately. teirminaited.
10..2
Termination for cause. Either Party may terminate there loP for ca1.1se i.fthe other
Pilil'ty commits a mater1tal bread'! of a ;fral\ll'leWOrk .Agreement, and fails to cure: its
militem breath witllii1 thirtv (00) days of receMt'II notice specifying the r'IBtUl'e of
sl.lClh lt:nead1 in weasmatrle detail from the non-breaching .P.illrty; provided., ooweve~,
that if Upstream Ql?!S is diligently VIClll'ting to cure its material breach at the end of
this·~· (30) day period, then You must pr!OVide Upstream QPS witti up to another
thirty (30} days to •domplete Its CWli.
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10. Term.. Ter1'1'11m8timt, Mid Suspension.
Federal Register / Vol. 89, No. 85 / Wednesday, May 1, 2024 / Notices
1113
Effeg ofTenpinatmfll. Upon tertmnatiiffl of these ToP, You. wiH ntl 11:mger be ,dlie to
engage m TEFO\ ~ l\'aallitated by or t h ~ Upstream Qf'S.. Jo the e:ittent
Yw st:me Tl, such 11 may not be dis'liirlgui!Shable fin:n other mfmmatiori maintained
by You. When the Tl is not disl:inguishilibie t:om1 otl!er infim'mall:ion,, it is; not pos.sibfe
forYtiu to raum or desllroV TI Vcu maintain 11pt1n termination er e11.pic:atmn .of these
ToP. Upon Wln'iinall:ion oreiipirltion Of these IoP, if'You are su~jectto5et:don, 1 Of
these ToP, sucih seCl!icns shailJ <:ooooue to appt, m long as; the infortnatiori would be
ePHl if maintaiine.d bJ a Covered Entity or l!lminess. Associate. The protections.
required under tl'le HllfliM Security Rule shall aiB cooll:irwe oo appiy ta, aiU n that is
ePHI, reganless of whether Vw are a Cll¥ered Entity m BHiness; Asmciate. The
pfO!risions: set fmtl'I lin tniS Se!::tilCn uu are in addit.iori to those .lillmvil pnniisiol'IS
'set forth in SeCl!ion1L9.,
Ul.4
Clmflict With Other .Agreements Between You and Up.strtam. OPS. Natw\lthSta.nding
anything herein to the G'mtrary, in the event You and Upstream, QPS are parties ·to
an qreement dlat provides illddltimllill termsI relillkd to lEfCA • ~ and. ttlilt
agreemem pmvides for a shoner·notia:! period for terminall:icn, such shorter nOltic:e
period shall a:intrDI.
10..s
R'i!lhts to Suspend.
35177
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105.1 R.CE"s Right to Suspend Your Aliiilify to El\'li!ilge in 1tfCA &diamre. You
adnowledge and agree that the ACE has the allthority to suspend, or direct
the Upstream QPS to r.u.spend, any QPS's abli.ty to engage in lEFtA &diange
H: ti) there i's ao alleged violation of the respect.we Fra:nn:.•WOft Agreement or
Of Appli.cable Law by the respect.we pany/partie~; (ii) there is aThreat
Q,n,dltkln;, (Bi) ·the J«;E. deterrnmes that the safety or sec:urit:V of illl'IY persan
or the pnwcy er security afTI iiild/or -Confidemiail lnfomiation is threatened;
{ivl SIJch suspension is in the iiriterem of lliltional security il!i directed by an
agency of the United Stab!s: govemrnent;; or (vJ there in sit:ua.tioo in whid1
the .RtE may suffer mat,eriilf harm a n d ~ - is the only reasonable nep
that the Rtf can take to pn:Jtett itJellt 'too aclmaw1ed'ge that upon reoe:wmg
1:Hr:ectioo from the RCE., Yoo will be suspended as soon iH practic.able
pi:c,l!'llded, lmwever, if the suspe,miiffl .is based Ql1 SUbsec:timns 10..5. .lti) or
105.l{w) or a Threat Dmdl:tiion that results in a cog1'1Rilbie threat to the
semrro, of lEFCA. Exthillnge or the mformatiori that ·\the RCE. reasonably
believe.s is TI,. then Yau willf be .sius,pended withi.n twenty-four (M) hour.s of
the RCE !"laving directed Y:oor QHIN to effectuate the wspeiltsicm,. unless the·
RCE specifies a lm,ger period of time is 1Pennmed.
35178
Federal Register / Vol. 89, No. 85 / Wednesday, May 1, 2024 / Notices
10.:5.• 2
YPStearn Ar:Sii Right lg SYSIC!]d Dmr f+bjlihl t!p MR: ID IfFQ+ Ep;IJIJ'lle:
You atknowtedge and aer:ee that Upstream QPS has the same ai.11:hmity as
the ACE to wspend y;oor abiity ·t:o engage in TEFCA Exdlane:e.; and Your
S~pillrtidpant's ,(if any) abiliity to engage m.TEFCA &change, if'iln'II of the
arwmstances described in Subsedions 1115.1 (iHiii) above ,oa::uir 'llrith
respect· to Yem or any of Your Subpan:icipantSc.
Upstream QPS. map eerme such right to -.spend based on its
of the drrilmstances desaibed m
Subseciiions.10.:5,.l (iHiii) above m:i:urred with respe,ct to Yoo er
any of Your Subpartii:ipants.
OWlfl de!:erminatioo that any
Upstream QPS ,m,m exercise such right to suspend if direaed to
do so by the RCE or ilt:S I.Jipstr,eam OPS based on its determination.
$11: suspemm is w:aml'llted based on any ofthe dn::umstani:es
desaibed m Subsections lllS.l <wHv) above• with respect to Vau
or any ,cflour .Subpartidpants.
You ack11owtedge that it Upstream QP.s make.s a determmiiltmn
thilt suspension iS waml'llted. or receNes mrettiDn fnlm its
Upstream QP.S to .suspendYmJT ablity to enpge iri TE:ftA
Ext::bange, You will be suspended as sacn as praciikiilble pn:Mded,
howieller. iflhe suspension is based oo the drtum5ltiilnces
desc::ribed mSUbsettions 10..S:l(i) at :10:$..ltiv) or a Tht eat
Ccmditiic:m thatresuits in a cognizable tmem to the. :security of
TEFCA 'fxchang,e or the mformatioo ·that the ICE reil!Sonabty
befiieVes is TI, then You will be suspended Within twientJ·four 124)
1
1
hooH of notice of Upstream.iQPS's determination or receipt of
direction fimm its Upstream QPS, IJll"lles!i Upstream QPS specifies a.
I ~ period ,of time is pennitted.
10.:5..3 Upstream Cf:S SUmeMion. NotlM:thstal"ldiOI the foriegDing; m the e:vent t"'at
Upstream QPS's iillbiliity to engage in TEfCA Exchange i's suspended, Your ,and
any of YOtJr SUbpanitipants' abUitf to e ~ in TEfCA Ex.change 'will be
mimediiltely suspended.
10.s.-, suspension ffi!hts G@nted to You Related to vow: S@BOid1ffillllu. 1noo
hiiJVe Sl.lbpartiti,palnt:s, You atkrmwledge and agll!e thanou have: tile same.
responsibility and authority to suspend Your .SUbpartidpant"s. iillbillty to
engage mTEFCA Exdlange if any of the cin:umstani:es dem'ibed. in
Subsections: lD.5..1 (i}-{ii) atiove· oa:ur wltll respect to any of Your
~J)amidpants.. If Yoo miill:e .i detenninatim to suspend, You are required.
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Federal Register / Vol. 89, No. 85 / Wednesday, May 1, 2024 / Notices
35179
to promptly l'IICltify Upstream QPS ,cf Your dedsmn lillml the r:e:ason{sJ for
mak'irle; tl'le· dedSlion. If arr,i of Your .SUl:lpanidpants notify V,oo. of ffieir
decismn to suspend. exduirige with ·d:Jeiir· Subp.itlticipanlt(s), .You must rttif\l'
Upstream QPS of sudh decien.
•
You may exercise. sui::11 right to suspend based on ¥curOV11n
determination that any oftl'le· di'wmstrm:es desclribed in
Subsedims 1.tl.:5~1 UMiii) above· ocained with respect to. any of
Your :Subpanicipants.
You must exercise such irigiht to suspend iif directed to do so; by
ltle ICE or Upstream QPS bared on ltle RCE's determinatieln. that
sus:pen51icn is wa1rr.mted based on any of the ciircifJmistances;
deSll:lrtbediifl Slll:JS'ettionslo.5.1 (i)-1).!) aboveWlillh respect 11D any Of
Your :Subpal'tkipants.
1(iii)
YOiU mu.st ,effectuate.sum .s1.1spensioo of Your Subpairtidip.mt as
soon a:s practitail:m! pllll'llided,. however. if t:fle suspeinskln is based
on the an:1.1mst.ainteS de.scribed in Subsectioos :m•5.l(i) or
105.l(liv) or iii nnem: COm:ltion Ihm res!..lllts in a mgmzal:lle threat
t:o the sewrit, Of JEFCA &idh~ or ltle iinformaition tnanhe RCf
1reasooably believes iis TI, thein It must be: effectuated within
twent,-fo1.1r (24) incurs of tile triggeri"I e\l'el'lt., unless ,a longier
period ,alf time is: permitted. for p.irposes of this sul:l!iiectioo, the
triggering event is Voor dtterminatioo to s1.1spe~ Your li'ece~ of
clirettioo firtlm yow- Upttream: QPS, to suspend, ,or lhe .RCE hning
directed Y1:111r QHl.ff to effmuate 1d'iie s1.1spenslorn.
1115.5 Seiective .suspensfion. 'i'OiU may, in .good faiffi and t:o the extent pennAtted by
Applitaible Law:; detemine that You must S1.1Spend exd,aneq with a QlilN,
P,ati'ticipant, or Stlbpaniqpant with which You are. othenvise requilred to
e«hanee iin accordiince with 11111 SOP because ot re1SOnable and legitimate
mn.cems related to the privacy, sec.utity~ aa:111racv, or ~llty of infonnatioo
1tlm: is exchangeut lfY,oo make thils determination, v:au.are required'ta
pll>lq>tiy notify Upstream QPS.of Yo1.1r deci.mm and the reason(s) for making
u,e· decision. If any ,cf Your Subparticipal!lts notify You of ltleir deeim::m.to
suspend l!!Khange with. a QHIN,. Partidpant, or S1.1bpartiapilll'lt, '111ou ml.$
notify Upstream QPS of such dedsieln. Yoo ad:nowiedge that 'l'oit.i may be
req1.1ired to
in a pr:ccess fildilitated by ltle .ICE to feSCl\re whatever
mues led to the decision to s1.1spel'ld.. Provided ffiat Y:cu semivety s:usper.d
enpg,e
exmaneir\11 with another QHIIN. Participant, er SUbpartiitipanit in accorda1nce
With this. section and in iliCJtordilnoe with Applicable I.aw~ 5Uth sdedive
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Federal Register / Vol. 89, No. 85 / Wednesday, May 1, 2024 / Notices
suspensmn mall not be deemed a \liotation of Section 2.2 of these TiQP,
11.. Contnld Administratm111.
11Jt
Authority u, Agree~. You. wammt and represent. that You have the full power and
authority t10 enter into these ToP..
112
Assignment Nooe of these ToP ain be·ti'ansfieJrred l:lyfilher·flany, im:luding:
Whether blf mignment, merger; other cpel'iltion of law, change of con~ (!i.e., sale
of submlntialty, au of the assets; •of the Party) ofthe Party or otherwise, without the
prim written a1:i1novat of the other Party.
U.3
Seyerabilrt,y. If any pr'O\liiSion Of these T()!> shall be adj.itJdged by ·ill'IY COUit of
mmpetent xurisdii:tian to be unenfm'ceable or invalid, thlt prc,WSioo shal be stn.lCk
from the ToP, and the remaining provisions of these ToP shill remain in full fl:lrce·
and effect and enforceable ..
U.4.
Ciptiprls. Captions appearing in these lt1P are far mnveniience on!y and.shall not be
deemed to expl!il1n, limit, or ,iffllplify the pl'O'll'i.smns of these To?.
n.:s
Independent Parties. Nm:hing,cantained in these Toll shall be deemed or aiMtrued
.as ere~ a joint venture or partnership between Upstream .QPS and Voo.
.1U
Acts af'O:ffitrad:ors and Agents. To the extenll:that the acts«criS,sions:.Dfa Party's
aeentts) or mntntttor(s), or their submntnicto,ts),. resiult in that Partfs breach of
and liabiflty undertttesieTDP, said breadh shilllbedeemed be.a breach by 1ll'lat
Party.
VerDate Sep<11>2014
U.7
Waiver. The failure of. either Party kl.enfar,ce, at any 1:Wme., ill'l'f .provwoo of these
ToP Shall not be cOl'li!iltl"1.I to. be a waiver ot: sun ~on, oor shall ii: in any way
affect ·me vllidty.of these Toi' or aif'I!/ pan hereof arthe. right of sUth Pany
thereafter m enforce il?lilch and e!flelrV such provision. No Williver of anv breKh ,Df
1hese ToP shall be held ltO amstiitulle a 'waiver of any other or subsequent breadl,
nor mill any delay by eirlher Party to e1ercise any right underthes,e Toll operate as a
waiver of any such right.
1UI
~ - In the evem·or a,y .conflict ,or inconsistency betwieen any other agreement
ihillt Yoo and Upstream, Q.PS enter into with il"eSpect to TEFCA Elllc.l1an1e. Applicable
law, iii prc:Msicm of these To?, the Qlf,, an SOP, al'ldjorany implementaticn plans,
guidance documents., or 11ther materiials or documentation the R.C:E makes available
to QHINs; flilrtidpants, an~ar SU'bpartidpants ~a~g the operawns or activities
tondUcted imder the framework. Agreements:; t.he fol!IUW!ing shall be. the ,order of
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35181
precedence ~at ·ttiese TiDP to the extent of such conl'lirt .a, mnnsist:ency: ,(1)
AppliGlble law; (2) these 'TD?; (3) the QTf; 141 the SOPs; (5) all other attachments,
exhibits, and artal:!s int:orpQMecil herein 1,y rerereir1ce; ,f&} •Dl!:her RCE plim,
doctme111~. Ill" materials made a1tilil:able i'egarding aictivities ,conducted under the
framework Agreements; ;md 17:1 any m:her agreemelllt that You am:I Upstream QPS
enter· irlto with respect to.TEFCA Excnairv,e..
1UI
~ - The !Following sections of ttiese TioP shilll su!V'Ne expim'ticn or termmation
of.these ToP as more specifically provided below:
.(i)
Sedioo 3, O::fflfidenti&tit:y and Acmuntability sharl Sll.ln!ive f:or a period ct m
(6) yearsfml!JWmg·the expira:tioo orternlinatioo of these Toi''.
(1i)
:Section 6..4, SUNivaU'or IAS Providers, to the extent that.You are an IAS ·
Prmnder, s.hilll survive fsDl!owffle: the expiratilm « termimrticm of thes:ei loP
for the respective time periods set bth in Se:rtkln 6.4.
(iii).
Secdm 1, Priwcy, tu the einentthatYou .are subject t:o Sectilm 1, said
:Section mall SUl'Wlfe• the 19piratmn or termmat!im of these To? m long as the
mfarmatiffl'i maintained by You ·would be. ePHI if maimamed bf a 0:wered
<tity or Business Assooilte.
(iv)
••
•
:Section 8.1 Sewriqr Ocmtrds, am:! :Section Its, &la'yptiion, to, the extent that
You are. subject to Sediions 8.1 and 8.5, said Sec:11:mn or SediDl'IS Shall survive
the e:xpiraticm ar termination of these fop for so tong as the iinfmmatioo
ma.intained. by You would be. ePHI iif maintained by a covered Entity or
fl111sines.s Assoone regardless Of 'll'llhel.her You are a t'aiiered Entity or
B111sines.s Aswciate..
(vi
The requirements of Settm 8,.2, TfFCASerurity Incidents Reporting, shall
suririve ·for a pemxl ,of six (6) years mflOWing the expiratmn :or teffl'liinatien of
thesieloP.
•
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Federal Register / Vol. 89, No. 85 / Wednesday, May 1, 2024 / Notices
Januarv 2022
November:2023
Venioo:Ll
DndtVemon2.0
Venion2Jl
75
Suhas Tripathi,
National Coordinator for Health Information
Technology.
[FR Doc. 2024–09476 Filed 4–30–24; 8:45 am]
16:59 Apr 30, 2024
Final HHS National Environmental
Policy Act Compliance Procedures to
Incorporate Federal Flood Risk
Management Standard Procedures
Assistant Secretary for
Administration, Department of Health
and Human Services (HHS).
ACTION: Notice; final procedures.
AGENCY:
In accordance with Executive
Order 13690 of January 30, 2015—
Establishing a Federal Flood Risk
Management Standard and Process for
SUMMARY:
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Soliciting and Considering Stakeholder
Input, HHS is publishing its final
floodplain management procedures to
include climate science if an action
takes place in a floodplain.
The final procedures are in effect
on the May 1, 2024.
DATES:
FOR FURTHER INFORMATION CONTACT:
CAPT Leo Angelo Gumapas,
Environmental Engineering Program
Chief, at 202–669–6942 or by email at
leoangelo.gumapas@psc.hhs.gov, for
clarification of content.
SUPPLEMENTARY INFORMATION:
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Common Agreement Version 2.0 is
also available on the Office of the
National Coordinator for Health
Information Technology’s public
internet website at www.HealthIT.gov/
TEFCA.
Authority: 42 U.S.C. 300jj–11.
]]>Agencies
[Federal Register Volume 89, Number 85 (Wednesday, May 1, 2024)]
[Notices]
[Pages 35107-35182]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-09476]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Office of the Secretary
Notice of Publication of Common Agreement for Nationwide Health
Information Interoperability (Common Agreement) Version 2.0
AGENCY: Office of the National Coordinator for Health Information
Technology, Department of Health and Human Services.
ACTION: Notice.
-----------------------------------------------------------------------
SUMMARY: This notice fulfills an obligation under the Public Health
Service Act (PHSA) that requires the National Coordinator for Health
Information Technology to publish on the Office of the National
Coordinator for Health Information Technology's public internet
website, and in the Federal Register, the trusted exchange framework
and common agreement developed under the PHSA. This notice is for
publishing an updated version of the Common Agreement (Version 2.0).
FOR FURTHER INFORMATION CONTACT: Mark Knee, Office of the National
Coordinator for Health Information Technology, 202-664-2058.
SUPPLEMENTARY INFORMATION: This notice fulfills the obligation under
section 3001(c)(9)(C) of the Public Health Service Act (PHSA) (42
U.S.C. 300jj-11(c)(9)(C)) to publish the trusted exchange framework and
common agreement, developed under section 3001(c)(9)(B) of the PHSA (42
U.S.C. 300jj-11(c)(9)(B)), in the Federal Register. This publication
consists of the following document:
BILLING CODE 4150-45-P
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Common Agreement Version 2.0 is also available on the Office of the
National Coordinator for Health Information Technology's public
internet website at www.HealthIT.gov/TEFCA.
Authority: 42 U.S.C. 300jj-11.
Suhas Tripathi,
National Coordinator for Health Information Technology.
[FR Doc. 2024-09476 Filed 4-30-24; 8:45 am]
BILLING CODE 4150-45-C
