What a BAA covers when your practice uses AI

A vendor that handles patient information on your practice’s behalf is a business associate, and a business associate needs a written agreement with you. AI vendors are no exception. “Does this vendor have a BAA?” is a fair first question. The better one is what the BAA actually covers.

What the law requires of the contract

The Privacy Rule lists what a business associate contract must contain (45 CFR 164.504(e)). Among other things the vendor must agree not to use or disclose the information except as the contract or the law allows, to use appropriate safeguards and, for electronic information, comply with the Security Rule, to report any use or disclosure the contract does not provide for, including breaches of unsecured information, and to make sure its own subcontractors that handle the information accept the same restrictions. At the end of the contract the vendor must, if feasible, return or destroy the information and keep no copies or, if that is not feasible, extend the contract’s protections to what remains.

It covers named services, not a brand

A BAA covers what it names. OpenAI’s Healthcare Addendum (version 111124) defines its Eligible Services as the Zero Retention API, ChatGPT Enterprise and any other service OpenAI identifies in writing. It then lists what is not eligible: third-party services, API use that is not through an approved organization ID, and API use to an endpoint that is not eligible for zero retention.

Google’s HIPAA page for Google Cloud lists the products its BAA includes and tells customers to disable unsupported services when working with patient information: “If you can’t disable a service, you must not use it for PHI.” It also says not to use pre-GA offerings with patient information unless a notice or the offering’s own terms say otherwise.

Both providers carve out add-ons. Google’s Workspace page says: “Third-party applications including add-ons are not included in the Included Functionality covered by the BAA.” OpenAI’s addendum excludes “Third Party Services,” which it defines to include plugins, actions, third-party GPTs and collaboration features such as shared links and templates, unless OpenAI’s HIPAA guide permits them.

It does not make your practice compliant

Google’s HIPAA guide notes that the Department of Health and Human Services “doesn’t offer a certification program for HIPAA compliance,” and that Google Cloud and Google Workspace “support HIPAA compliance within the scope of a Business Associate Agreement, but ultimately you are responsible for evaluating your own HIPAA compliance.” OpenAI’s guide says following it “does not ensure compliance.” The practice still owes its own risk analysis: the Security Rule requires “an accurate and thorough assessment of the potential risks and vulnerabilities” to electronic patient information the practice holds (45 CFR 164.308(a)(1)(ii)(A)).

A cloud provider is a business associate even without a decryption key

The Office for Civil Rights says so in its cloud computing guidance: a cloud provider that maintains encrypted patient information for a covered entity “is a business associate, even if it does not hold a decryption key.” The practice and the provider “must enter into a HIPAA-compliant business associate agreement.” Putting an assistant in your own cloud account does not remove the need for the provider’s BAA.

Who signs with whom

In a small practice three agreements are worth checking. The first is with the AI or cloud provider, for the named services. The second is with any firm that installs or supports the tool and can see or handle patient information while it does: the federal definition of a business associate covers a person who creates, receives, maintains or transmits protected health information for a covered entity, and a person who provides consulting, management or administrative services to a covered entity where the service involves disclosure of protected health information to that person (45 CFR 160.103). The third sits one level down. A vendor’s own subcontractors that handle patient information must be bound too (45 CFR 164.502(e)(1)(ii)), so ask who they are.

Read these before you sign

• The exact service, plan and features named. Anything not named is not covered.
• What the agreement excludes: add-ons, plug-ins, connectors, early-access features, anything labeled preview.
• Retention and deletion: how long inputs and outputs are kept, and whether you can set it to none.
• Breach reporting: how soon the vendor must tell you, and what it must include.
• Subcontractors: which ones touch patient information, and that they accept the same terms.
• Ending the contract: what is returned or destroyed, and when.

This is general information, not legal advice. Ask your own counsel about your practice.

Where this comes from

Each passage in quotation marks is copied from one of these pages as we read it on October 23, 2026. Providers change their pages, so open the current version before you rely on a passage.

• 45 CFR 164.504(e), business associate contracts
• 45 CFR 160.103, definitions (business associate)
• 45 CFR 164.502(e), disclosures to business associates
• 45 CFR 164.308(a), Security Rule administrative safeguards
• OpenAI, Healthcare Addendum and BAA (version 111124)
• OpenAI, HIPAA Implementation and Configuration Guide (posted July 9, 2026)
• Google, HIPAA compliance on Google Cloud and Google Workspace
• Google, HIPAA compliance with Google Workspace and Cloud Identity
• HHS Office for Civil Rights, Guidance on HIPAA and Cloud Computing (content last reviewed December 23, 2022; we read the Internet Archive copy of December 31, 2025)