Los Angeles County Municipal Code Part 6 Special Provisions

5.27.530 - Limitations on Prior Benefits.¶

Notwithstanding any other provision of the Los Angeles County Code, a Participant's entitlement to the benefits set forth in this Subdivision 2 shall be subject to the following limitations:

Vacation Benefits.

No Participant shall earn or accrue vacation benefits after January 1, 1991, or the date the Participant commences participation in the Plan, whichever occurs later (hereinafter referred to as the "Vacation Ending Date"). On the Vacation Ending Date, each Participant who is otherwise eligible for vacation benefits, as set forth in Chapter 6.18, shall receive a final crediting of vacation time. Such final crediting shall be calculated as follows:

In any case where the Participant's Vacation Ending Date coincides with his vacation anniversary date, he shall receive a final crediting of vacation time equal to the number of working days of vacation to which he would normally be entitled on said date pursuant to the provisions of Chapter 6.18.

In any case where the Participant's Vacation Ending Date does not coincide with his vacation anniversary date, he shall receive a final crediting of vacation time equal to the number of working days of vacation to which he would otherwise be entitled if he were terminating County service on his Vacation Ending Date and receiving leaving vacation benefits pursuant to the provisions of Chapter 6.18; provided, however, that no Participant shall receive any such final crediting of vacation time unless he has worked for the County for at least one year in a capacity that would otherwise entitle him to vacation benefits.

All vacation time earned and credited to the books up through and including the Vacation Ending Date shall remain available for use or payoff at termination of County service pursuant to the rules set forth in Chapter 6.18; provided, however, that there shall be no limitations on the accrual and carryover of such time.

Full-Pay Sick Leave Benefits. No Participant shall earn or accrue full-pay sick leave benefits after December 1, 1990, or the first day of the month prior to the date the Participant commences participation in the Plan, whichever occurs later. All full- pay sick leave credited to the books up through and including December 1, 1990, or the first day of the month prior to the date the Participant commences participation in the Plan, whichever is applicable, shall remain available for use or payoff at termination of County service, pursuant to the rules set forth in Chapter 6.20; provided, however, that no such time shall be used for personal reasons.

Part-Pay Sick Leave. Effective January 1, 1991, no Participant shall be eligible to receive part-pay sick leave benefits set forth in Chapter 6.20 unless he is receiving such benefits on December 31, 1990, and continues to be absent from work on January 1, 1991 for the same cause, in which case, he shall be allowed to continue to receive the part-pay benefits to which he would otherwise be entitled until he returns to work.

Industrial Injury Leave Benefits.

No Participant who is a general member of the Los Angeles County Employees Retirement Association shall be eligible to receive industrial injury leave benefits set forth in Section 6.20.070 of this Code with respect to any industrial injury occurring on or after January 1, 1991. Nothing herein shall be construed to limit any Participant's entitlement to Workers Compensation benefits authorized by state law.

In the event a Participant is absent due to an industrial injury incurred on or after January 1, 1991, and the absence is charged to Nonelective Annual Leave, Elective Annual Leave, vacation, sick leave, accumulated holiday time or accumulated overtime, and the injury is subsequently determined to be compensable by the Chief Administrative Officer or the Workers Compensation Appeals Board, the Participant shall be entitled to a partial restoration of such time pursuant to the Election Information.

Long-Term Disability and Survivor Benefits.

Effective January 1, 1991, no Participant shall be eligible to receive disability benefits under the Long-Term Disability and Survivor Benefit Plan set forth in Chapter 5.38 of this Code unless (a) he is receiving such benefits on December 31, 1990, or is otherwise eligible to receive such benefits, but has not yet completed the Qualifying Period required under said Plan, and (b) he continues to be absent from work on January 1, 1991 for the same cause. In such case, the Participant shall be deemed to be covered by the provisions of Chapter 5.38, including both disability and survivor benefits, until he returns to work. Further, during such period, such Participant shall be deemed ineligible for benefits under the Long-Term Disability Plan set forth in Part 4 of this Chapter 2. Effective March 1, 1991, no Participant shall be eligible for survivor benefit coverage under Section 5.38.040 except as provided under subsection 1 above.

Nonelective Life Insurance. Effective January 1, 1991, no Participant shall be eligible for the life insurance benefits provided under Sections 5.36.070 and 5.36.075 of this Code.

(Ord. 2008-0073 § 4, 2008; Ord. 90-0164 § 1 (part), 1990.)

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5.27.600 - Privacy of Protected Health Information.¶

This section applies to both Subdivision 1 and Subdivision 2 and contains the Plan provisions required by the Standards for Privacy of Individually Identifiable Health Information and for the security of Electronic Protected Health Information ("PHI"), set forth in 45 CFR § 164.102 et seq., as amended from time to time, and any successor thereto (collectively, the "Privacy Rules") promulgated under Title II of the Health Insurance Portability and Accountability Act of 1996, as amended ("HIPAA"), relating to the permitted disclosure of PHI by the Plan to the County. The provisions of this section shall apply to the Plan for so long as such portion of the Plan constitutes a "health plan" under HIPAA and, as such, is subject to the HIPAA Privacy Rules.

Except as otherwise provided in this section, the provisions of the Plan, including any definitions therein, shall apply to this section; provided, however, that the provisions of this section shall supercede any conflicting or inconsistent provision of the Plan.

Definitions. The following terms, when capitalized, will have the meanings set forth below for purposes of this section, unless otherwise specified herein:

"Covered Person" means any eligible employee or former employee of the County or an eligible spouse or dependent thereof who participates in the Plan.

"Electronic Protected Health Information" means PHI that is maintained in, or transmitted by, electronic media (as defined in 45 CFR § 160.103).

"Individually Identifiable Health Information" means information, including demographic information collected from an individual, that:

Is created or received by a health care provider, health plan, employer, or health care clearinghouse (all as defined in the Privacy Rules);

Related to the past, present, or future physical or mental health or condition of an individual, the provision of health care to an individual, or the past, present, or future payment for the provision of health care to an individual; and

Identifies the individual; or with respect to which there is a reasonable basis to believe the information can be used to identify the individual.

"Notice" means the notice of privacy practices for PHI required to be provided by the Plan to a Covered Person pursuant to the Privacy Rules.

"PHI" means Individually Identifiable Health Information that is transmitted or maintained in any form or medium; provided, however, that PHI does not include Individually Identifiable Health Information in education records covered by the Family Educational Rights and Privacy Act, as amended, 20 U.S.C. § 1232g, records described at 20 U.S.C. § 1232g(a)(4)(B)(iv), and employment records held by a covered entity (as defined in 45 CFR § 160.103) in its role as employer.

"Plan Administration Functions" means administration functions performed by the County on behalf of the Plan, but excluding functions performed by the County in connection with any other benefit or benefit plan of the County.

"Policies and Procedures" means those Comprehensive Privacy Policies and Procedures with respect to PHI established and maintained by the Plan pursuant to the Privacy Rules.

"Privacy Official" means that person designated by the County in the Policies and Procedures to implement and enforce the Policies and Procedures.

"Required by Law" means a mandate contained in law that is enforceable in a court of law and includes, but is not limited to:

Court orders and court-ordered warrants;

Subpoenas or summons issued by a court, grand jury, governmental or tribal inspector general, or administrative body authorized to require the production of information;

Civil or an authorized investigative demand;

Medicare conditions of participation with respect to health care providers participating in the program; and

Statutes or regulations that require the production of information.

"Summary Health Information" means information that may be Individually Identifiable Health Information, and:

That summarizes the claims history, claims expenses or type of claims experienced by individuals for whom the County had provided health benefits under the Plan; and

From which the information described at 45 CFR § 164.514(b)(2)(i) has been deleted, except that the geographic information described in 45 CFR § 164.514(b)(2)(i)(B) need only be aggregated to the level of a five-digit zip code.

Identity of Plan Sponsor.

The County shall be the plan sponsor for purposes of the Privacy Rules when using or disclosing PHI in accordance with subsection C of this section and when otherwise acting on behalf of the Plan with respect to the Plan's obligations under the Privacy Rules.

The Privacy Official shall act for the plan sponsor, and shall be entitled to delegate its powers and responsibilities in accordance with its usual practices.

Individuals and classes of individuals identified in subsection E of this section shall assist the Privacy Official.

Permitted Uses and Disclosure of PHI.

The Plan may disclose (or permit a health insurance issuer or HMO with respect to the Plan to disclose) an individual's PHI to the County if authorized by the individual to make such disclosure in accordance with the Privacy Rules. In addition, the Plan may disclose (or permit a health insurance issuer or HMO with respect to the Plan to disclose) to the County information on whether an individual is enrolled or disenrolled in the Plan and may disclose Summary Health Information to the County, provided the County requests Summary Health Information for the purpose of:

Obtaining premium bids from health plans for providing health insurance coverage under or on behalf of the Plan; or

Modifying, amending, or terminating the Plan.

Except as provided in subsection C1, the Plan may disclose (or permit a health insurance issuer or HMO with respect to the Plan to disclose) PHI to the County only for the purpose of performing Plan Administration Functions (subject to obtaining

written certification from the County as described in subsection D of this section). Only those individuals identified in subsection E of this section will be permitted to access and use PHI disclosed under this subsection C2, and may access and use it solely for the purposes of performing Plan Administration Functions, consistent with any conditions or restrictions imposed on, or otherwise agreed to by, the County pursuant to this Section, or as Required by Law.

The Plan shall not disclose (or permit a health insurance issuer or HMO with respect to the Plan to disclose) PHI to the County unless the Notice contains the statement required by 45 CFR § 164.520(b)(1)(iii)(C).

Notwithstanding any provisions of the Plan to the contrary, in no event will the County be permitted to use or disclose PHI in a manner that is inconsistent with 45 CFR § 164.504(f).

The Plan may otherwise use and disclose PHI in accordance with the Privacy Rules and the Plan's Policies and Procedures.

PHI Disclosure Conditions. The Plan will disclose (or permit a health insurance issuer or HMO with respect to the Plan to disclose) PHI to the County as provided in subsection C2 of this section only if the County certifies in writing that the Plan has been amended to require the County to agree, and that the County does in fact agree that, with respect to any PHI disclosed to it by the Plan, it will:

Not use or further disclose the PHI other than as permitted or required by the Plan or as Required by Law;

Ensure that any agents, including a subcontractor, to whom it provides PHI received from the Plan agree to the same restrictions and conditions that apply to the County with respect to such PHI;

Not use or disclose the PHI for employment-related actions and decisions or in connection with any other benefit or employee benefit plan of the County, (except to the extent such other benefit plan, program or arrangement is part of an organized health care arrangement of which the Plan also is a part);

Report to the Plan any use or disclosure of the information that is inconsistent with the uses or disclosures provided for of which it becomes aware;

Make PHI available to an individual who requests access to his or her Health Information in accordance with 45 CFR § 164.524;

Make PHI available for amendment and incorporate any amendments to PHI in accordance with 45 CFR § 164.526;

Maintain and make available information required to provide an accounting of disclosures in accordance with 45 CFR § 164.528;

Make its internal practices, books, and records relating to the use and disclosure of PHI received from the Plan available to the Secretary of the Department of Health and Human Services for the purposes of determining compliance by the Plan with Subpart E of 45 CFR § 164;

If feasible, return or destroy all PHI received from the Plan that the County still maintains in any form, and retain no copies of such information, when no longer needed for the purpose for which the disclosure was made, except that, if such return or destruction is not feasible, limit further uses and disclosures to those purposes that make the return or destruction of the information infeasible; and

Ensure that the adequate separation between the Plan and the County, required in 45 CFR § 164.504(f)(2)(iii), is established.

Separation between the Plan and the County for Plan Administration Functions. Only the following employees or classes of employees or other persons under the County's control will be permitted to access and use PHI for Plan Administration Functions in accordance with subsection C of this section:

Department Positions

Department of Human Resources Director of Personnel

Department of Human Resources, Employee Benefits Senior Human Resources Manager and all Human Division Resources Analysts

Department of Human Resources, Administrative Services Senior Human Resources Manager and all Human Division, Fiscal Services Section Resources Analysts

Office of the County Counsel Designated Deputies

Chief Executive Office—Benefits and Compensation Division Senior Manager, Manager, and all Principal Analysts, CEO

PHI disclosed to the aforementioned parties under subsection C1 of this section may be accessed and used only for purposes of performing Plan Administration Functions.

Disciplinary Sanctions and Mitigation of Harm. In the event that any employee specified in subsection E of this section does not comply with the provisions set forth in this section, that employee will be subject to disciplinary action by the County (which may include termination) for such non-compliance, as set forth in the Policies and Procedures. In addition, the Plan will take all necessary action to mitigate any harm caused by an employee's failure to comply with these provisions.

Compliance with Health Privacy Laws. To the extent applicable, the Plan will comply with Subpart E of 45 CFR § 164 and any other applicable federal, state, and local laws governing the safeguarding of health privacy matters.

Interpretation of HIPAA Privacy Rules. The provisions of this section are meant to comply with (and not expand upon) the requirements of the HIPAA Privacy Rules and shall be interpreted accordingly. In the event that any of the provisions of this

section are not applicable, are superceded, or are no longer required under HIPAA, they shall be deemed to be deleted from the Plan and shall have no further force or affect.

Security Standards for Electronic PHI. In order to safeguard any Electronic PHI created, received, maintained, or transmitted to or by the County on behalf of the Plan, the County shall:

Implement administrative, physical, and technical safeguards that reasonably and appropriately protect the confidentiality, integrity, and availability of the Electronic PHI that it creates, receives, maintains, or transmits on behalf of the Plan;

Ensure that the adequate separation between the Plan and the County required by subsection E and 45 CFR § 164.504(f)(2) (iii) is supported by reasonable and appropriate security measures;

Ensure that any agent, including a subcontractor, to whom it provides Electronic PHI agrees to implement reasonable and appropriate security measures to protect that Information; and

Report to the Plan any security incident of which it becomes aware.

(Ord. 2015-0063 § 6, 2015.)

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