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o. HIPAA Regulations. "HIPAA Regulations" mean the standards for privacy of Individually <br /> Identifiable Health Information and the security standards for the protection of Electronic <br /> Protected Health Information as promulgated under 45 C.F.R. Parts 160 and 164 by the U.S. <br /> Department of Health and Human Services under the Health Insurance Portability and <br /> Accountability Act ("HIPAA") of 1996 and the Health Information Technology for Economic and <br /> Clinical Health Act(the"HITECH Act")of the American Recovery and Reinvestment Act of 2009,in <br /> effect on the Effective Date of this Agreement and as may be amended,modified,or renumbered <br /> hereafter. <br /> p. individual. "Individual"has the meaning ascribed to this term in 45 C.F.R.§160.103 and includes <br /> a personal representative in accordance with 45 C.F.R.§164.502(g). <br /> q. Individually Identifiable Health Information["IIHI")."II1-11"means information that is a subset of <br /> health information, including demographic information collected from an individual, and, <br /> employer,or health care clearinghouse;and(2)Relates to the past,present,or future physical or <br /> mental health or condition of an individual;the provision of health care to an individual;or the <br /> past, present, or future payment for the provision of health care to an individual; and (1) That <br /> identifies the individual; or ill With respect to which there is a reasonable basis to believe the <br /> information can be used to identify the individual. <br /> r. Minimum Necessary Standard. "Minimum Necessary Standard"has the meaning ascribed to that <br /> term in 45 C.F.R. § 164.502, and this standard must be used in all situations described in that <br /> section as situations to which the standard applies. <br /> s. Natural Person. "Natural Person" means only living people. <br /> t. Participating Entity. "Participating Entity"means any person or entity owned or controlled by or <br /> under the supervision of Participant that will by means of the signature authority of Participant <br /> access or use Data covered under this Agreement. <br /> u. PCCM Network. "PCCM Network"refers to any of the entities defined as a PCCM Network under <br /> the State Plan of North Carolina or approved as a PCCM Network by the State. <br /> v. Permitted Purpose. "Permitted Purpose" includes the following activities, provided those <br /> activities are performed in compliance with all Applicable Laws: <br /> L Treatment.Treatment means the provision,coordination, or management of health care and <br /> related services by one or more healthcare providers. <br /> ii. Hearth Core Operations.Health Care Operations includes quality assessment and improvement <br /> activities, Including outcomes evaluation and development of clinical guidelines; population- <br /> based activities relatingto improving health,reducing health care costs,protocol development, <br /> case management and care coordination. <br /> iii. Payment.Payment means activities undertaken by:(1)a Health Plan to obtain premiums or to <br /> determine or fulfill its responsibility for coverage and provision of benefits under the health <br /> plan; or (2) a health care provider or Health Plan to obtain or provide reimbursement for <br /> providing health care, Payment activities include (1) determinations of eligibility or coverage <br /> (including coordination of benefits or the determination of cost sharing amounts), and <br /> adjudication or subrogation of health benefit claims; (2) risk adjusting amounts due based on <br /> Enrollee health status and demographic characteristics; (3) billing, claims management, <br /> Page 4 of 21 <br />