Form Cms-R-0235 - Agreement For Use Of Centers For Medicare & Medicaid Services (Cms) Data Containing Individual Identifiers Page 4

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9. The User agrees not to disclose direct findings, listings, or information derived from the file(s) specified in section 5,
with or without direct identifiers, if such findings, listings, or information can, by themselves or in combination with
other data, be used to deduce an individual’s identity. Examples of such data elements include, but are not limited to
geographic location, age if > 89, sex, diagnosis and procedure, admission/discharge date(s), or date of death.
The User agrees that any use of CMS data in the creation of any document (manuscript, table, chart, study, report,
etc.) concerning the purpose specified in section 4 (regardless of whether the report or other writing expressly
refers to such purpose, to CMS, or to the files specified in section 5 or any data derived from such files) must
adhere to CMS’ current cell size suppression policy. This policy stipulates that no cell (e.g. admittances,
discharges, patients, services) 10 or less may be displayed. Also, no use of percentages or other mathematical
formulas may be used if they result in the display of a cell 10 or less. By signing this Agreement you hereby agree
to abide by these rules and, therefore, will not be required to submit any written documents for CMS review. If
you are unsure if you meet the above criteria, you may submit your written products for CMS review. CMS agrees
to make a determination about approval and to notify the user within 4 to 6 weeks after receipt of findings. CMS
may withhold approval for publication only if it determines that the format in which data are presented may result
in identification of individual beneficiaries.
10. The User agrees that, absent express written authorization from the appropriate System Manager or the person
designated in section 20 of this Agreement to do so, the User shall not attempt to link records included in the
file(s) specified in section 5 to any other individually identifiable source of information. This includes attempts to
link the data to other CMS data file(s). A protocol that includes the linkage of specific files that has been approved
in accordance with section 4 constitutes express authorization from CMS to link files as described in the protocol.
11. The User understands and agrees that they may not reuse original or derivative data file(s) without prior written
approval from the appropriate System Manager or the person designated in section 20 of this Agreement.
12. The parties mutually agree that the following specified Attachments are part of this Agreement:
____________________________________________________________________________________
13. The User agrees that in the event CMS determines or has a reasonable belief that the User has made or may have
made a use, reuse or disclosure of the aforesaid file(s) that is not authorized by this Agreement or another written
authorization from the appropriate System Manager or the person designated in section 20 of this Agreement,
CMS, at its sole discretion, may require the User to: (a) promptly investigate and report to CMS the User’s
determinations regarding any alleged or actual unauthorized use, reuse or disclosure, (b) promptly resolve any problems
identified by the investigation; (c) if requested by CMS, submit a formal response to an allegation of unauthorized
use, reuse or disclosure; (d) if requested by CMS, submit a corrective action plan with steps designed to prevent
any future unauthorized uses, reuses or disclosures; and (e) if requested by CMS, return data files to CMS or
destroy the data files it received from CMS under this agreement. The User understands that as a result of CMS’s
determination or reasonable belief that unauthorized uses, reuses or disclosures have taken place, CMS may refuse
to release further CMS data to the User for a period of time to be determined by CMS.
The User agrees to report any breach of personally identifiable information (PII) from the CMS data file(s), loss of
these data or disclosure to any unauthorized persons to the CMS Action Desk by telephone at (410) 786-2580 or
by e-mail notification at cms_it_service_desk@cms.hhs.gov within one hour and to cooperate fully in the federal
security incident process. While CMS retains all ownership rights to the data file(s), as outlined above, the User
shall bear the cost and liability for any breaches of PII from the data file(s) while they are entrusted to the User.
Furthermore, if CMS determines that the risk of harm requires notification of affected individual persons of the
security breach and/or other remedies, the User agrees to carry out these remedies without cost to CMS.
Form CMS-R-0235 (06/10)
4

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