OBJECTIVE: This article provides the Business Associate Agreement form to be completed by IN Help at Home employees.
Click the attached PDF to complete the Business Associate Agreement.
Business Associate Agreements need to be completed for:
- Waiver companies
- Skilled Companies
- Assisted Living facilities.
- Group homes
- DD Companies
Completing the Business Associate Agreement:
- Complete the Business Agreement indicating who is the primary company (typically the higher skill level) and what services are provided by each company
- Send to administrator for review and signature
- Upload the unsigned copy to the original cert period (for current PA admission)
- Fax to the company and upload the fax success to the original cert period (for current PA admission)
- Continue to follow up with the company until it has been received back signed documenting your attempts in communications. If re-faxed-upload successful receipts to attachments.
If agency/company refuses to sign:
- Document in communications the attempts to send and/or agency/facility that is refusing to sign and return
- If they fax the document back with a note stating they will not sign, upload that in attachments and label as the refusal for reference
- If they call and state they refuse to sign, document who you spoke with along with date/time in communications note.
ยง484.105(e)(2) An HHA* must have a written agreement with another agency, with an organization, or with an individual when that entity or individual furnishes services under arrangement to the HHA's patients.
*HHA is referring to Home Health Agency
Click the attached PDF to complete the Business Associate Agreement.
Source: IN Branch Staff