Would appreciate your comments on the following BA issue:

 

For payer-provider relationships (the "payer" I'm referring to is a State Government agency which pays for health care delivered by private sector providers to its "clients),  is there a requirement to accomplish a Business Associate agreement to formalize this relationship?

 

My interpretation is that, in this situation, neither entity is technically performing activities "on behalf of the other."  The Privacy Rule specifically addresses non-treatment based services:  legal, actuarial, accounting, consulting, management, administrative accreditation, data aggregation, and financial services... as being the primary candidates for BA agreements.  Further, to again reference the regulation:

 

    We also add language to the final rule that clarifies that the mere

fact that two covered entities participate in an organized health care

arrangement does not make either of the covered entities a business

associate of the other covered entity. The fact that the entities

participate in joint health care operations or other joint activities,

or pursue common goals through a joint activity, does not mean that one

party is performing a function or activity on behalf of the other party

(or is providing a specified services to or for the other party).

 

 

So, my practical view is that a BA agreement is not required in the above payer-provider situation. Appreciate your thoughts....

 

Thanks very much,

 

Steve Giesecke, MBA, FACHE

Independent HIPAA Consultant

Washington State


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