Deborah -- You are correct that group health plans are covered entities and as such are obligated under HIPAA to accept standard transactions. Consequently, group health plans must file an ASCA compliance plan by 10/16/02 to receive the 1 year ASCA grace period unless the group health plan qualifies as a small health plan (<$5 million in annual revenues.) Small health plans automatically have a 10/16/03 compliance date. The small health plan exemption should be available to many group health plans which eases the burden on employers, and remember there is no small provider exemption. I trust that insurers, HMO's and TPAs are coordinating this process with employers, but in the words of President Reagan, "trust but verify."
As for your second question, if the group health plan is fully insured, then the insurer or HMO is also a covered entity with respect to the group health plan. If the insurer or HMO provides administrative services only, then it is a business associate of the group health plan. Remember if the group health plan is fully insured, then it generally is exempt from the Privacy Rule's administrative requirements, provided that the only PHI that the plan sponsor receives from the group health plan (or its insurer or HMO) is enrollment data and/or summary information as defined in the rule (� 164.504(f), 164.530(k)). Best regards, David Ermer >>> Deborah Campbell <[EMAIL PROTECTED]> 09/03/02 01:39PM >>> Forgive my ignorance, but I can never seem to get my hands completely around this Group Health Plan thing. Both insured and self-funded group health plans are covered entities if they use an insurer or TPA to administer their plan and they have 50 or more participants. It has been made clear to me that even if a GHP uses an insurer to administer their plan, they are still a CE and need to apply for the TCS extension. But here are my questions: 1) This means that almost every employer in the US will need to apply for the extension, or have their insurer apply on their behalf, correct? And this is whether they are self-funded or not. 2) Does this make the insurer a BA of the group? This would mean as an insurer, we would probably need to apply for an extension on behalf of almost every group we have and have BA Agreements with them all. This seems extreme, like I'm missing something. Any help is appreciated. Deborah Campbell Compliance Coordinator Dominion Dental Services, Inc. 115 South Union Street, Suite 300 Alexandria, Virginia 22314 Phn: (703) 518-5000 ext. 3035 Fax: (703) 518-8849 Toll Free: 888-518-5338 Email: [EMAIL PROTECTED] ******************************************* The information in this email is confidential and may be legally privileged. It is intended solely for the addressee. Access to this email by anyone else is unauthorized. If you are not the intended recipient, any disclosure, copying, distribution or any action taken or omitted to be taken in reliance on it is prohibited and may be unlawful. ********************************************************************* The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. Posting of advertisements or other commercial use of this listserv is specifically prohibited. Gordon & Barnett 1133 21st St., NW, Suite 450 Washington, DC 20036 202-833-3400 ext 3009 (voice) 202-223-0120 (fax) www.gordon-barnett.com The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. Posting of advertisements or other commercial use of this listserv is specifically prohibited.
