Home Health & Hospice Week

If you haven’t correctly identified all your associates, you could be at risk.

Ignorance is not bliss when it comes to HIPAA compliance and non-healthcare provider business associates.

The protection of data is fully outlined for covered entities (CEs) in the HIPAA Privacy Rule.

But most home health and hospice agencies rely on other, nonhealthcare business associates (BAs) to successfully address and administer patient care. The compliance of those vendors is essential for a provider to stay out of hot water.

Make sure your agency remains HIPAA compliant by knowing what protected health information (PHI) can be disclosed, and to whom, and when. Brush up on these particulars concerning Bas and business associate agreements (BAAs).

Understand Who Qualifies As A Business Associate

“A ‘business associate’ is a person or entity that performs certain functions or activities that involve the use or disclosure of protected health information on behalf of, or provides services to, a covered entity,” says the HHS Office for Civil Rights. “A member of the covered entity’s workforce is not a business associate. A covered health care provider, health plan, or health care clearinghouse can be a business associate of another covered entity.”

Tip: Those who may have access to PHI include not only attorneys and accountants, but also computer and medical hardware repair businesses, EHR-software vendors, off-site billing and coding companies, and physical security providers.

Most agencies almost definitely work with at least one BA — but probably utilize many others, too. Here are some examples, as outlined by the OCR:

• “A third-party administrator who assists a health plan with claims processing.
• “A CPA firm whose accounting services to a health care provider involve access to protected health information.
• “An attorney whose legal services … involve access to protected health information.
• “A consultant who performs utilization reviews.
• “A healthcare clearinghouse that translates a claim from a nonstandard format into a standard transaction on behalf of a health care provider and forwards the processed transaction to a payer.
• “A pharmacy benefits manager that manages a health plan’s pharmacist network.”

Take These Precautions

While BAs are technically exempt from HIPAA regulations, CEs can only disclose PHI if “the providers or plans obtain satisfactory assurances that the business associate will use the information only for the purposes for which it was engaged by the covered entity, will safeguard the information from misuse, and will help the covered entity comply with some of the covered entity’s duties under the Privacy Rule,” the OCR says.

To remain compliant, in most cases, your agency must have contracts with these partners.

These contracts or BAAs must specify the particular times and terms that the BA can disclose, access, or otherwise utilize PHI. You can find a sample contract here: www.hhs.gov/hipaa/for-professionals/coveredentities/sample-business-associate-agreementprovisions/index.html.

“Covered entities who have business associate agreements already in place should have their business associate agreements reviewed so that the appropriate amendments can be made if necessary, and those covered entities without business associate agreements in place should have such agreements drafted immediately,” say attorneys Mathew J. Levy and Stacey Lipitz Marder with Weiss Zarett Brofman Sonnenklar & Levy in New Hyde Park, New York, in a blog post.

“In addition to having compliant business associate agreements in place, covered entities need to make certain that their privacy and security policies, as well as HIPAAauthorization forms, are compliant, and that their staff is informed of such changes,” Levy and Lipitz Marder add.

Beware Of Tricky EHR Cloud Storage

Take extra precaution if your agency stores EHRs or other PHI on the cloud, through a cloud services provider (CSP).

Hint: To remain compliant, it’s crucial that you have a BAA in place and signed before moving forward with the cloud storage of electronic PHI.

This is vital because your agency could get the blame for any ePHI mishaps by BAs, so make sure your agreements are airtight.

“It’s not uncommon for healthcare organizations to go beyond HIPAA requirements in their BAAs, using the document as the basis for service level requirements, too. If your BAA is that comprehensive, check for language about how you want your partner to demonstrate compliance, as well as what cybersecurity requirements, if any, are specified,” says Grant Elliott, CEO of Ostendio in Arlington, Virginia, and co-founder and president of the Health Care Cloud Coalition.

Even if you’ve covered your bases with an initial BAA, it’s time to reevaluate your contracts.

“If you’ve had the same standard contract for a while, review it,” Elliot says. Check to see whether you can audit the security program, whether there have been any amendments since the contract was drawn up and signed, and consider whether the contract needs any updates as cyberattacks become increasingly clever and frequent, he recommends.

Expert advice: There’s a reason why the OCR as well as the National Institute of Science and Technology (NIST) have stringently defined what a CSP is and what HIPAA protocols must be in place for dealings with cloud providers. “Not all cloud vendors are alike. It is more nuanced than that,” says Kurt J. Long, founder and CEO of FairWarning Inc. in Clearwater, Florida. “Look for third-party evidence when choosing a cloud vendor for your EHR — a good-looking website does not equate to a mature product or adequate security.”

Remember: Trust is paramount in the handling of such sensitive data. “Transparency promotes trust,” Elliot says. “If your CSP does have a compliance program, ensure you have a system or process in place that allows you to easily keep an eye on their ongoing privacy and security actions. It’s reassuring for both parties, and can make a difference when called on to officially demonstrate you’re on top of privacy and security.”

Note: Check out the OCR’s advice on HIPAA and cloud computing at www.hhs.gov/hipaa/for-professionals/special-topics/cloud-computing/index.html.