Case managers sometimes are confused as to what constitutes a "business associate" as referred to in the Health Insurance Portability and Accountability Act (HIPAA), notes Cathy Kauffman-Nearhoof, RN, BSN, CCM, NMCC, CLNC, owner of Integrist Healthcare Consulting in Duncansville, PA. When case managers are working for health care facilities and insurance companies, she notes, the issue is of lesser concern, since the details typically are managed by corporate attorneys and privacy officers. However, smaller case management entities and independents must identify their business associates and apply appropriate business agreements and policies, Kauffman-Nearhoof says. To determine who is a business associates, consider the following:
Step 1. Check each applicable statement.
- Does the outside organization perform services for or on your behalf?
- Does your business or organization disclose protected health information (PHI) to the outside entity?
If you did not check both boxes, the organization in question is not your business associate. If you checked both boxes, go to step 2, below.
Step 2. Check each applicable statement.
- Does the outside organization receive PHI to provide treatment?
- Is the outside organization a financial institution processing consumer-related transactions for the purpose of payment for health services?
- Is your contract with the organization one within which you both participate in an organized health care arrangement or where you’re both in an affiliated arrangement?
If you checked any of the boxes above, the organization is not your business associate. If none of the boxes are checked, the organization is your business associate, and you should prepare a business associate agreement.
What’s next? You’ve found relationships that qualify as business associates. In those situations, case managers need to prepare a business associate contract. Because the role of case managers is not yet defined clearly by the Department of Health and Human Services (HHS), we look to the agency for further guidance regarding this and other components of HIPAA regulations. For now, use these steps to prepare business associate contracts:
A. Prepare your list of current contracts.
B. Review your current contracts and agreements to identify and categorize each business associate relationship.
C. Identify contract renewal dates for current business associate relationships and update and revise in accordance with the most current guidance from HHS. (Go to: www.hhs.gov.)
A. Identify and list each organization you have identified as a business associate.
B. Create a business associate agreement.
C. If you developed new agreements prior to April 14, 2003, HIPAA language should have been inserted into the agreement as an addendum if a new agreement was not developed.
D. Create new and ongoing agreements when you assess new business relationships are business associates.