To answer Jim's question at the end of his excellent post, I do believe there is
a downside to executing a BA agreement when none is otherwise required. The
primary downside, in my view, is to voluntarily impose certain obligations via
contract (a BAA is, after all, a contract) on the ambulance service that it
would otherwise not have directly under HIPAA. Plus you undertake certain
contractual obligations to the facility when HIPAA only imposes obligations to
the patient. Assuming voluntary contractual obligations to a facility under a
BAA only adds compliance burdens to a covered entity.



Douglas M. Wolfberg
Page, Wolfberg & Wirth, LLC
5010 E. Trindle Road, Suite 202
Mechanicsburg, PA 17050
(717) 691-0100
Sent via Blackberry

-----Original Message-----
From: "hipaaems@yahoogroups.com" <hipaaems@yahoogroups.com>

Date: Sat, 19 Apr 2008 05:21:47
To:"hipaaems@yahoogroups.com" <hipaaems@yahoogroups.com>
Subject: [HIPAA & EMS] Digest Number 8


HIPAA & EMS


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Messages In This Digest (2 Messages)


1a.
Re: PCRs at the hospital From: Jim Kelly 1b.
Re: PCRs at the hospital From: Barton Regan

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1a.


Re: PCRs at the hospital
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Posted by: "Jim Kelly"
cfems@... <mailto:cfems@...?Subject=
Re%3A%20PCRs%20at%20the%20hospital>  
emtpkelly
<http://profiles.yahoo.com/emtpkelly>

Fri Apr 18, 2008 7:37 am (PDT)

> Will,
>
> If your agency has executed a valid "business associates" contract
> with the hospital in question, it is legal and advisable to leave a
> PCR with them, after all HIPAA never intended that patient care should
> be compromised by a lack of communication. The reality is that your
> agency should execute such an agreement with every facility they
> transport to and keep them on file.
> -BR
>

Hmm, this brings up another issue. The clear consensus among attorneys
who have addressed the issue with us, as well as folks (attorneys and
others) in the mainstream HIPAA lists and groups, is that a BAA between
covered entities is unnecessary if the only service the two CEs are
performing is treatment.

§ 160.103 of the Privacy Rule defines a business associate as follows
(with references to "organized health care arrangement" omitted for the
sake of brevity and because most EMS agencies presumably are not part of
an OHCA):
"(1) Except as provided in paragraph (2) of this definition, business
associate means, with respect to a covered entity, a person who:
(i) On behalf of such covered entity ..., but other than in the capacity
of a member of the workforce of such covered entity ..., performs, or
assists in the performance of:
(A) A function or activity involving the use or disclosure of
individually identifiable health information, including claims
processing or administration, data analysis, processing or
administration, utilization review, quality assurance, billing, benefit
management, practice management, and repricing; or
(B) Any other function or activity regulated by this subchapter; or
(ii) Provides, other than in the capacity of a member of the workforce
of such covered entity, legal, actuarial, accounting, consulting, data
aggregation (as defined in § 164.501 of this subchapter), management,
administrative, accreditation, or financial services to or for such
covered entity ..., where the provision of the service involves the
disclosure of individually identifiable health information from such
covered entity or arrangement, or from another business associate of
such covered entity or arrangement, to the person."
So it clearly states that, in order to be deemed a business associate,
an entity must be performing one of these (non-treatment) services on
behalf of a CE. Multiple CEs treating the same patient are providing
their service directly to the patient, and nothing (listed or otherwise)
on behalf of a CE.

An example as we have applied it: We have a volunteer EMS agency in our
county that uses our billing company. They also use us as the
go-between for sending PCR data to the company, receiving EOBs and other
related documents and reports from the company, customer service,
collection efforts, etc. We have a BAA with that agency where we are
considered their business associate. We don't have BAAs with other EMS
agencies in the area, nor (back to the point) with the area hospitals.

Therefore, Barton, it seems clear that BAAs with receiving hospitals are
not required by the Privacy Rule. Nor do I believe (back to Will's
original question) that that should be a factor in whether his agency
should leave PCRs with them. As some of us have said, their potential
role in treatment seems to be justification enough.

Now, a question for the masses: If Barton and others still choose to
execute them, is there any downside?

Jim




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Re: PCRs at the hospital
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Posted by: "Barton Regan"
bregan@... <mailto:bregan@...?Subject=
Re%3A%20PCRs%20at%20the%20hospital>  
geobug2000
<http://profiles.yahoo.com/geobug2000>

Fri Apr 18, 2008 2:35 pm (PDT)

Boy Jim, that sure clears up a lot of issues for us, if I can get our
attorney to agree.Thank you.
BR--




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