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TO
THE RESCUE: elaws
- Health Benefits Advisor
The
Department of Labor (DOL), as of third quarter 2003, has launched the "elaws
- Health Benefits Advisor" web site to help employers deal with the
complexities of laws (like COBRA, HIPAA, etc.), dealing with Group Health
benefits. Please click onto the following link to learn more:
http://www.dol.gov/elaws/ebsa/health/
HIPAA,
is a Law that followed COBRA Law in 1996, and is a further "expansion of
COBRA"; however, it deals mainly with the issue of health coverage
portability (i.e. the ability of an insured who has exhausted COBRA extended
benefits, to then be able to obtain replacement, non-Group coverage, but on a
guaranteed issue basis, and regardless of negative health history).
Additionally, its provisions apply to all sized Groups including not only 2-19
(as in the Cal-COBRA provisions), or 20-50 (as in the Federal COBRA provisions)
and where 2-50 are defined in CA as "small Groups", but to ALL Groups
sized 2 or more employees.
COBRA & HIPAA Laws are
subject to regular amendments; therefore, for the most up to date information
please contact the following:
Overview of HIPAA and
COBRA, see IRS Notice 98-12, available on the IRS home page at:
http://www.irs.gov
NEW HIPAA COMPLIANCE DEADLINE ANNOUNCED
Medical Industry E-Mail News Service via Davis, Wright, Tremain, LLP
HIPAA Transaction & Code Set
(TCS) Rules - Extension Offer by DHHS
WASHINGTON DC USA -- The US Department of Health & Human Services (DHHS) released the model form for HIPAA-covered entities under the Health Insurance Portability & Accountability Act of 1996 (HIPAA) -- to request a year's extension in complying with the HIPAA Transaction & Code Set (TCS) rules.
The present TCS compliance deadline is Oct. 16, 2002 (except for small health plans). With the extension, the new deadline will be Oct. 16, 2003; however, the extension is not automatic. A covered entity must submit an extension request by Oct. 15, 2002 to receive the extension. This extension is the result of the Administrative Simplification Compliance Act passed by Congress in late 2001 and signed into law by President Bush in Jan. 2002.
Filing Procedure:
The model form (or a similar form) must be filed with DHHS to obtain the extension. Filing is sufficient to obtain the extension -- there is no approval process with respect to the submitted form. Simply filing the model form with DHHS makes the extension automatic. The form can be filed electronically. DHHS will have an electronic filing system in operation shortly, probably within a week. DHHS will send an electronic acknowledgement of the filing.
The model form also may be filed by mail. In that case, DHHS will not acknowledge receipt. DHHS recommends that covered entities filing by mail use a return receipt, so that way they will have proof of filing.
Completing The Form:
The form requires each covered entity to furnish information about its implementation strategy and budget for complying with the HIPAA Transaction & Code Set rules. DHHS expects every covered entity to have a TCS implementation strategy and budget. The DHHS extension form divides the implementation plan into three phases:
(1) HIPAA Awareness.
(2) Operational Assessment.
(3) Development and Testing.
The form features a series of short questions. Some are "yes-no" or multiple choice (from a menu of choices). Others require supplying a date (such as when a phase of TCS compliance was or will be completed).
Should Covered Entities File For The TCS Extension:
In most cases, the answer will be "yes."
The simple fact is that DHHS and various "Designated Standards Maintenance Organizations" or "DSMOs" are still refining the implementation guides to the TCS standards. Changes to the TCS implementation guides, often referred to as the "addenda," are expected to be issued by DHHS in the coming months. It will be more efficient and less expensive for covered entities to implement and test the standards after the next round of changes. Those changes, however, are unlikely to be made before the current deadline in Oct. 2002. That is one reason why an extension makes sense.
Moreover, a covered entity's compliance with the TCS standards is dictated to some degree by the compliance of its business associates and trading partners. Because the TCS standards are going to change, and because most of the industry will seek the extension, chances are good that many business associates and trading partners will not in fact meet the TCS standards in Oct. 2002. A covered entity cannot accurately represent to DHHS that it is in compliance with the TCS rules, if its trading partners apply for the extension and require the covered entity to submit or accept noncompliant transactions.
Finally, DHHS made every attempt to simplify the extension process. The form is streamlined and easy to complete. There is no filing fee for submitting an extension request.
Any covered entity (other than a small health plan) that does not request an extension must be in compliance with the existing TCS standards as of Oct. 16, 2002 -- less than seven months away.
Among other things, a covered entity cannot be in TCS compliance unless all its HIPAA business associate-trading partners are also in compliance. Because the TCS standards are going to change, and because most of the industry will seek the extension, chances are good that many business associates will not in fact meet the TCS standards in Oct. 2002. That would be trouble for any covered entity that did not seek the extension and that has trading partner relationships with non-TCS compliant business associates.
Moreover (assuming the form is filled out accurately -- see below), there is no regulatory or business disadvantage to seeking an extension. It costs nothing. The form is streamlined and extremely easy to complete.
Any grant of the extension is automatic upon filing. It is fair to say that DHHS expects most covered entities to seek the extension.
Things To Keep In Mind:
This extension is for Transaction & Code Sets only. It does not change the compliance date for the HIPAA Privacy compliance, which is April 14, 2003. [Note also that Section 164.530(c) of the HIPAA privacy rules includes a general requirement for security as well, with the same compliance date -- April 14, 2003.] This date is specified by Congress, so DHHS does not have power to change it.
In order to obtain the TCS extension, a covered entity is required to begin testing its TCS implementation no later than April 16, 2003, six months before the extended TCS compliance deadline of Oct. 16, 2003. Therefore, covered entities should not use the extension as an excuse to procrastinate.
Conclusion:
Finally, a covered entity that files the form and obtains the TCS compliance extension is representing to DHHS that it has a HIPAA TCS implementation plan and budget. A covered entity should be very careful in filling out the form, to ensure that the responses accurately reflect the entity's TCS plan and budget.
LeagueFinancial.com partners with
several third party COBRA/HIPAA Administrators to manage such compliance matters
for its
clients. We have found that the added costs are well worth the savings in
rather substantial
fines and penalties that, more often than not, most employers incur due to lack
of a complete understanding of such compliance matters.
[NOTE:
This information is intended as a guide and as general information , is not
definitive, and is f or illustrative purposes only.
The information contained herein is not intended to be used as a replacement to the
Law, to any legal forms, or to any legislative and/or other requirements.]
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