Non-Intermediary Participants are not permitted to charge fees for the Exchange of HSSI for a Required Purpose under the DSA. This is true whether they use their own technology, a QHIO, an Intermediary that has signed the DSA but is not a QHIO, or an Intermediary that has not signed the DSA.

A Participant shall not charge fees to any other Participant for any Exchange of Health and Social Services Information under the Data Exchange Framework for a Required Purpose. (DxF Fees P&P, Section II.1.a.)

All Participants have a duty to respond to requests for HSSI and must fulfill that duty by providing the information in accordance with Applicable Law OR other appropriate response.

All Participants shall respond to requests for Health and Social Services Information made by other Participants and shall share Health and Social Services Information when required under the Permitted, Required, and Prohibited Purposes Policy and Procedure. A Participant shall fulfill its duty to respond by either providing the requested Health and Social Services Information it Maintains in accordance with the Data Sharing Agreement (the “DSA”) and Applicable Law; or… providing an appropriate error message or null response as specified by the technical standard in use and in accordance with the Technical Requirements for Exchange Policy and Procedure. (DxF Requirement to Exchange Health and Social Services Information P&P, Section III.1.a)

Non-Intermediary Participants that use an Intermediary that is not a QHIO to meet DxF requirements must obtain assurances that the Intermediary provides services in such a way as to allow the non-Intermediary Participant to comply with the DSA and its P&Ps, regardless of whether the Intermediary is a DxF Participant or not. This includes obtaining reasonable assurances that the Intermediary meets the non-Intermediary Participant’s duty to respond and does not charge fees to other Participants other than their own contracted client for the Exchange of their HSSI for Required Purpose

If a Participant elects not to execute an agreement with a Qualified HIO and instead elects to use its own technology or to execute an agreement with another entity that provides data exchange, the Participant must comply with or obtain reasonable assurances that the other entity enables the Participant to comply with, the minimum requirements for data exchange set forth in the Policies and Procedures or Specifications. (DxF DSA, Section 7(a).)

Non-Intermediary Participants that choose to execute a contract with an Intermediary to help them meet DxF requirements, however, may be charged fees by that Intermediary, in accordance with the DxF Fees P&P:

A Participant shall not charge fees to any other Participant for any Exchange of Health and Social Services Information under the Data Exchange Framework for a Required Purpose. However, a Participant that is an Intermediary may charge fees to another Participant if the Participant that is an Intermediary has executed a contract with the other Participant to provide services. For contracts to provide services to assist another Participant in meeting its obligations under the Data Sharing Agreement, the fees shall be consistent with Applicable Law, including but not limited to the Fees Exception in the Federal Information Blocking Regulations. (DxF Fees P&P, Section II.1.a.)