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Why a FedRAMP Stamp Doesn’t Eliminate All Risk: Questions to Ask Your Telehealth Vendor

mmybody

2026-02-07

10 min read

FedRAMP is a baseline — learn the contract clauses and SLAs clinics must demand for data portability, exit plans, and sustained support in 2026.

Hook: FedRAMP is a strong signal — not a shield

If your clinic equates a FedRAMP stamp with “zero risk,” you’re betting patient data and operations on an incomplete promise. In 2026, telehealth vendors winning FedRAMP authorization is increasingly common — but authorization addresses a defined federal security baseline, not the full set of operational, legal and continuity risks clinics face. Before you sign that vendor contract, you need precise answers about data portability, service-level guarantees, an enforceable exit strategy, and ongoing support commitments.

The evolution of FedRAMP and telehealth risk — why this matters now

From late 2024 through 2025 federal and commercial cloud standards accelerated toward continuous monitoring, stronger supply-chain vetting and tighter AI governance. By early 2026, telehealth platforms have adopted FedRAMP as a competitive differentiator. That’s good — but it created two downstream dynamics clinics must plan for:

More vendors with a FedRAMP Authorization to Operate (ATO) — and more transactions (mergers, spin-offs, re-architectures) that change how data is handled.
Rapid AI feature rollouts that depend on customer data. Regulators and standards bodies (including NIST-based AI guidance adopted across healthcare organizations between 2023–2025) now push for explicit controls on model training and secondary data use.

Put simply: a FedRAMP ATO confirms a vendor met a security baseline at assessment time, but it doesn’t automatically protect you from contractual gaps, portability failures, degraded service levels or unexpected secondary uses of your patients’ health data.

What FedRAMP covers — and what it doesn’t

FedRAMP provides: an independent security assessment of cloud implementations against federal baselines, continuous monitoring requirements, and a traceable authorization process (JAB or agency ATO).

FedRAMP doesn’t guarantee: business continuity commitments tailored to your clinical workflow, HIPAA compliance for every configuration (HIPAA obligations still require a Business Associate Agreement), vendor behavior during mergers, or contractual rights to your data. In 2026, regulators emphasize this gap: FedRAMP == security baseline, not a substitute for robust procurement contracts.

“FedRAMP is a floor — not a ceiling. Treat it as a starting point for contractual risk mitigation.”

Four risk areas clinics must address in telehealth procurement

When evaluating a FedRAMP-authorized telehealth vendor, prioritize four contract domains that commonly go under-specified:

Data portability & ownership
Service-level agreements (SLAs)
Exit & transition strategy
Sustained support, patching, and evidence of ongoing compliance

1. Data portability & ownership — demand precise technical and legal commitments

Questions to ask vendors (and demand in writing):

Who legally owns the data? (Answer should confirm: you retain ownership of PHI and patient-provided data.)
What export formats and APIs are available? Demand FHIR (R4+) bulk export, CSV for non-clinical exports, and documented REST APIs with OAuth2.0 support.
How fast will a full export be produced and delivered? Ask for concrete SLAs (e.g., full export within 15 calendar days, streamed exports available within 48–72 hours).
Are there portability fees or throttling limits? Ensure any fees are capped and performance limits disclosed.
Can we use Bring-Your-Own-Key (BYOK) or customer-managed encryption keys (CMKs)? If not, require escrow or other protections.

Contract language examples to include:

“Customer retains exclusive ownership of all PHI and Clinical Data. Vendor will provide a complete export in FHIR R4 Bulk Data format within 15 calendar days of written request without additional charge.”

2. SLAs — go beyond simple uptime percentages

Telehealth requires performance metrics tied to patient experience and clinical operations. Standard uptime numbers are necessary but insufficient. Include:

Uptime (99.9% for core services is a baseline; 99.95% preferred for high-traffic clinics)
Audio/video quality KPIs: call success rate, average latency, jitter and packet loss thresholds
MTTD (mean time to detect) and MTTR (mean time to respond) for security incidents — aim for MTTD < 24 hours and MTTR < 72 hours for critical incidents
Incident communication timelines (e.g., initial acknowledgement within 1 hour, incident summary within 24 hours, full RCA within 30 days)
Financial remedies: credits, capped refunds, or termination rights if SLAs are repeatedly missed

Sample SLA clause:

“Vendor guarantees 99.9% monthly uptime for telehealth session initiation and documentation services. Failure to meet uptime entitles Customer to service credits: 10% for single-month failures between 99.0–99.9%; 25% for <99.0%.”

3. Exit strategy — the contract’s most underrated section

Exit planning must be contractual, testable and inexpensive. Key items:

Data escrow for exports and critical code/artifacts required to restore service
Obligations to assist with transition: a defined transition period (e.g., 90 days), specified runbooks, and a minimum of X hours of migration assistance at no additional cost
Verification: require at least one yearly data export test and an independent restore test every 18 months
Post-termination data deletion and certificates of destruction within a defined timeframe (e.g., 30 days), with audit rights
Price guarantees for transition assistance to avoid vendor holding data hostage through steep fees

Contract snippet suggestion:

“Upon termination, Vendor will provide a full export in FHIR R4 Bulk Data format within 15 calendar days, supply migration runbooks and 120 hours of migration assistance at no charge, and certify secure deletion of remaining Customer Data within 30 days.”

4. Sustained support, patching and proof of ongoing compliance

FedRAMP authorization is not a one-time badge — continuous monitoring matters. Insist on:

Regular evidence of the vendor’s FedRAMP status and continuous monitoring artifacts (monthly scan summaries, vulnerability remediation timelines)
Commitments for critical vulnerability remediation (e.g., remediate CVSS >=9.0 within 7 calendar days, CVSS 7.0–8.9 within 30 days)
Third-party penetration testing frequency and ability to receive redacted reports; contractual right to trigger an independent audit on reasonable notice
Security contact and escalation path for zero-day and critical incidents

Targeted questions for vendor due diligence

Use this concise script during procurement interviews and include answers in your evaluation packet. Ask vendors to respond in writing and attach evidence.

What is your FedRAMP authorization path (JAB vs. Agency) and current ATO expiration or renewal status?
Do you operate at FedRAMP Low, Moderate or High? Provide the package and recent continuous monitoring reports.
Do you sign a HIPAA Business Associate Agreement (BAA) and what configurations alter HIPAA responsibilities?
What subcontractors/processors hold Customer Data? Provide a current vendor map and subcontractor attestations.
How is customer data segmented, encrypted, and backed up? Do you support CMKs/BYOK?
Do you use customer data to train models/service improvements? If yes, what opt-out, consent, and anonymization controls exist?
Describe your incident response timeframes and examples of recent incidents and remediations (redacted).
Provide sample export for a subset of Customer Data — can we do a test export during procurement?

Red flags that should trigger escalation

Vendor refuses to provide a data export test or caps exports behind steep fees.
Ambiguous data ownership language or permissive clauses allowing vendor use for “business improvement” without explicit consent.
No clear SLA for incident notification or remediation; no financial remedies for SLA breaches.
Vendor will not permit reasonable audit rights or disclose subcontractors who host or process PHI.
Vendor claims FedRAMP authorization but cannot provide recent monitoring artifacts or ATO documentation.

Practical procurement checklist & negotiation playbook

Follow this prioritized workflow to minimize risk and speed procurement:

Pre-RFP: Define non-negotiables (data ownership, export SLAs, BAA, FedRAMP level). Rank items by clinical impact.
RFP Stage: Include the targeted questions above and request evidence (FedRAMP package, SOC2, penetration test summaries, BAA draft).
Technical Validation: Run a vendor-initiated export test; validate restores in a sandbox tied to your EHR if possible.
Legal Negotiation: Insert concrete export timelines, transition assistance hours, audit rights and indemnities. Resist one-sided IP or data-use clauses.
Operational Readiness: Require annual export tests and post-contract termination drills; document runbooks and communication trees.

An anonymized example: what went wrong — and how it would have been prevented

In mid-2025, a regional clinic adopted a FedRAMP Moderate telehealth vendor that offered deep EHR integration and AI-powered visit summaries. Two years later the vendor was acquired and re-architected its platform to centralize logging and model training on pooled customer data. The clinic found their data exports delayed 45 days and faced a $75,000 quoted fee for a full archive export. Clinical workflows suffered during the delay, and the clinic had limited legal options because the original contract lacked strong export and transition clauses.

Lessons learned:

Require explicit export timelines and capped transition fees.
Insist on audit rights for subcontractors and advance notice of organizational changes (sales, mergers, re-architecture) with confirmed mitigation plans.
Prohibit vendor use of your data for AI/model training without written consent and compensation.

Advanced strategies to reduce residual risk

If your clinic handles high volumes of PHI or provides critical services, consider these layered mitigations:

Maintain independent backups of critical patient data in a neutral format (FHIR + CSV). Export monthly and store off the vendor environment.
Use a dual-run period during cutover: run vendor system in parallel for 30–90 days and validate data integrity and performance.
Negotiate escrow for encryption keys and critical configuration artifacts, with triggers for release (bankruptcy, acquisition, termination for cause).
Include contractual Zero Trust segmentation and to provide architecture diagrams showing PHI flow to and from third parties.
Include contractual model governance: opt-out for model training, data minimization, and audit logs proving de-identification methods.

Concrete contract snippets you can copy into drafts

Use these as starting points for negotiations with legal counsel:

Data Ownership: “Customer retains all rights, title and interest in Customer Data. Vendor shall not use Customer Data for any purpose other than provision of the Services unless Customer provides prior written consent.”

Export SLA: “Vendor will provide a complete export of Customer Data in FHIR R4 Bulk format within fifteen (15) calendar days of request, at no charge. Vendor shall offer a streamed export for critical subsets within forty-eight (48) hours.”

Transition Assistance: “Vendor will provide up to 120 hours of transition assistance during the first 90 days post-termination at no additional cost; additional hours billed at pre-agreed rates capped at $X.”

AI & Data Use: “Vendor will not use Customer Data to train models, create derivative AI products, or share with third parties for model training without explicit, documented Customer consent.”

Priority action items (what to do this quarter)

Audit existing telehealth contracts for missing export, SLA and transition clauses.
Require a live export test from each shortlisted vendor before final selection.
Insert explicit FedRAMP evidence and continuous monitoring requirements into procurement documents.
Negotiate a BAA and explicit prohibition on vendor-driven model training using your data without consent.
Plan for an annual restore test from vendor-supplied exports to prove your exit plan works.

Wrap-up: FedRAMP helps — but you must contract for the rest

In 2026 the telehealth market is maturing rapidly: more FedRAMP-authorized platforms, more AI features, and more vendor churn. That combination increases the importance of airtight procurement. Treat FedRAMP as a baseline security assurance and rely on your contract to cover portability, SLAs, exit mechanics, and long-term support. Your legal, compliance and IT teams should collaborate early to lock these items into RFPs and final agreements.

“Ask for proof, then contract for guarantees. The FedRAMP badge starts the conversation — the contract finishes it.”

Ready-made tools — what we can give you right now

If you want to move quickly, we can help with:

A 30-question vendor security and portability questionnaire tailored for telehealth procurement
Boilerplate contract clauses for data portability, export SLAs, escrow and AI governance
Guided vendor export and restore test scripts you can run before signing

Contact mybody.cloud to get the procurement checklist and sample contract language customized to your clinic’s size and clinical risk profile. Don’t let a FedRAMP badge lull you into complacency — demand the contract guarantees that protect patients, clinicians and your operations.

mybody

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