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Business Associate Agreement Template - Maine Department Of Health And Human Services

Maine Department of Health and Human Services

Business Associate Agreement

This Business Associate Agreement (“Agreement”) is made this ___ day of _________, 20___

(the “Effective Date”) by and between the State of Maine, Department of Health and Human

Services (the Covered Entity, hereinafter, the “Department”) and ________________________

(“Business Associate”), together (the “Parties”); and

WHEREAS, Business Associate may use, disclose, create, receive, maintain or transmit

protected health information in a variety of form or formats, including verbal, paper and

electronic (together, “PHI”) on behalf of the Department in connection with Business

Associate’s performance of its obligations under the following agreement between the parties:

____________________________________________________________________________

dated ___________, 20___ (the “Underlying Agreement”); and

WHEREAS, the Parties intend to ensure the confidentiality, privacy and security of

Department’s PHI as required by law, including the Health Insurance Portability and

Accountability Act of 1996, P.L. 104-191 (HIPAA), and its implementing regulations at 45 CFR

Parts 160 and 164 (the Privacy, Security, Breach Notification and Enforcement Rules or

“HIPAA Rules”) as updated by the Health Information Technology for Economic and Clinical

Care Act (HITECH) enacted under Title XII of the American Recovery and Reinvestment Act of

2009, and its implementing Regulations (together, the “HIPAA and HITECH Rules”); and

WHEREAS, the Parties agree that certain federal and state laws, rules, regulations and

accreditation standards also impose confidentiality restrictions that apply to this business

relationship, and may include, but are not limited to: 42 CFR 2 et. seq;, 5 M.R.S.A. §19203-D;

22 M.R.S.A. §§42, 261, 815, 824, 833, 1494, 1596, 1711-C, 1828, 3173, 3292, 4008, 5328,

7250, 7703, 8754; 10 M.R.S.A 1346 et. seq; 34-B M.R.S.A. §1207; 14-193 C.M.R, Ch. 1, Part

A, § IX; and applicable accreditation standards of The Joint Commission or other appropriate

accreditation body regarding confidentiality.

NOW THEREFORE, the parties agree as follows:

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Business Associate Agreement Template - Maine Department Of Health And Human Services