Declaración de subcontratista en el extranjero

Have you received HPP approval for offshore subcontracting?

Sí

No

If you answered “no”, please obtain HPP approval before submitting this form and before delegating HPP-related services to an Offshore Subcontractor.

Offshore subcontracting arrangement has policies and procedures in place to ensure that Medicare beneficiary protected health information (PHI) and other personal information remains secure.

Sí

No

Offshore subcontracting arrangement prohibits subcontractor's access to Medicare data not associated with the sponsor's contract with the offshore subcontractor.

Sí

No

Offshore subcontracting arrangement has policies and procedures in place that allow for immediate termination of the subcontract upon discovery of a significant security breach.

Sí

No

Offshore subcontracting arrangement includes all required Medicare Part C and D language (e.g., record retention requirements, compliance with all Medicare Part C and D requirements, etc.)

Sí

No

No corresponde

Sí

No

Organization will conduct an annual audit of the offshore subcontractor.

Sí

No

Audit results will be used by the Organization to evaluate the continuation of its relationship with the offshore subcontractor.

Sí

No

Organization agrees to share offshore subcontractor's audit results with CMS, upon request.

Sí

No

This attestation is for offshore subcontractors only.