In this Issue
October 15, 2002
First HIPAA Deadline for Employee Welfare Benefit Plans
Timetable for HIPAA Compliance by Employee Welfare Benefit Plans
Ober|Kaler Can Help Benefit Managers
Contacts:
Health Law
James B. Wieland
jbwieland@ober.com
Employee Benefits
John C. Baldwin
Marika M. Ostendorf
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The Health Insurance Portability and Accountability Act (HIPAA) establishes national standards for electronic health care transactions. October 16, 2002 is the deadline for "covered entities" to comply with these national standards. In general, after that date electronic health care transactions in ten specified categories must be conducted by all covered entities using only federally specified data formats and content. Standard transactions include health care claims or equivalent encounter information; health care payment and remittance advice; eligibility and referral certification and authorization. The deadline for compliance will be extended for one year, until October 16, 2003, for covered entities that file for an extension by October 15, 2002. potatoes
One category of entity covered under HIPAA is a "group health plan." A group health plan includes "employee welfare benefit plans," including insured and self-insured plans, to the extent that the plan provides medical care to employees or their dependents, directly or through insurance, reimbursement or otherwise, that has 50 or more participants or is administered by an entity other than the employer that established and maintains the plan. A "small health plan" has, under the Transaction Standards, until October 16, 2003 be compliant without the need for an extension. A small health plan is defined as " a health plan with annual receipts of $5 million or less."
The extension may be obtained by completing a simple form on-line. According to the government, it takes about 15 minutes. The government's instructions specifically state that upon completion of the filing "...you may consider your extension granted." The form can be accessed electronically at www.cms.hhs.gov/hipaa.
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October 16, 2002
- Electronic filing requirements are operative unless entity obtained an extension by October 15, 2002, except for "small health plans."
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April 14, 2003
- Amend plan documents to include protections for protected health information.
- Enter into written agreements with business associates, subject to transition period for preexisting relationships.
- Provide privacy notice to existing plan participants.
- Develop authorization forms.
- Designate privacy official.
- Designate individual responsible for receiving complaints.
- Train workforce.
- Implement compliance policies.
- Implement administrative and physical firewalls for the information.
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October 16, 2003 - Extended deadline to comply with electronic health care transaction requirements (if extension obtained by 10/15/02).
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April 14, 2004- End of transition period to revise contracts with business associates that were in writing by 10/15/02 and not subsequently amended.
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Ober|Kaler has combined the resources and experience of its health care practice and its employee benefits practice to prepare required employee welfare plan amendments. If you are interested in further information, please send an e-mail to info@ober.com and we will provide you with more details.
Copyright© 2002, Ober, Kaler, Grimes & Shriver
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