John,
In your explanation, you state that "if you are a self-insured plan and you
contract out EVERYTHING to a third party administrator ("TPA"), you are not
spared ANY of the requirements of the Privacy Rule. You must still prepare
and distribute an NPP to your participants and satisfy all of the Privacy
Rule's
administrative requirements."
Does this apply if you have contracted out your HR function to a PEO
(Professional Employer Organ.) that includes the administratio of the
benefit plans (health & dental) and the PEO is identified as the plan
sponsor / administrator of the group health/dental plans? Can the PEO
develop and distribute the NPP to the participants (employees)? Thank you,
Sue
Confidentiality Notice: This email message, includng any attachments, is for
the sole use of the intended recipient(s) and may contain confidential and
privileged information. Any unauthorized review, use, disclosure or
distribution is prohibited. If you are not the intended recipient, please
contact Hazen Group, Inc. at (317) 849-6065 and destroy all copies of the
original message.
Sue Ryan, RN, MPS
Consultant
Hazen Group, Inc.
Phone: (315) 468-2603
Fax: (315) 487-0153
----- Original Message -----
From: "John J. D'Amato" <[EMAIL PROTECTED]>
To: "WEDI SNIP Privacy Workgroup List" <[EMAIL PROTECTED]>
Sent: Thursday, March 13, 2003 1:48 PM
Subject: Re: Self insured health plans & NPP
> Hi, David and Bonnie.
>
> It's important to keep two terms distinct: "plan administration
functions"
> (which is a Privacy Rule term) and "plan administrator" (which is an ERISA
> term).
>
> The plan administrator (which, under ERISA, is the plan sponsor unless the
> plan document says otherwise) has certain reporting and disclosure
functions
> assigned to it by ERISA. The plan administrator may also be (but need not
> be) the named fiduciary for purposes of the claims adjudication procedures
> that a group health plan is required to have under ERISA.
>
> "Plan administration functions" is a poorly defined term in the Privacy
> Rule. What it appears to signify is performing those functions that make
a
> plan a covered entity--i.e., doing things that require working with PHI.
>
> Is the ERISA plan administrator necessarily a person who perform plan
> administration functions?
>
> No. So long as the ERISA plan administrator is not also the named
fiduciary
> for purposes of claims administration, it does not necessarily perform
plan
> administration functions on account of the jobs assigned to it by ERISA.
> That is because the jobs assigned to it under ERISA may be performed on
the
> basis of summary health information received and used for plan design
> purposes (permitted under the Privacy Rule) or eligibility and enrollment
> information (also permitted under the Privacy Rule).
>
> An ERISA plan administrator will perform plan administration functions,
> however, where it is also the named fiduciary for claims adjudication
> purposes, i.e., the person who has to receive all the PHI relevant to
making
> claims decisions.
>
> In addition, where a plan is self-insured, the plan sponsor will ALWAYS be
> assigned the full gamut of responsibilities under the Privacy Rule,
without
> regard to whether the plan sponsor contracts those functions out to a
third
> party.
>
> Thus, for example, if you are a self-insured plan and you contract out
> EVERYTHING to a third party administrator ("TPA"), you are not spared ANY
of
> the requirements of the Privacy Rule. You must still prepare and
distribute
> an NPP to your participants and satisfy all of the Privacy Rule's
> administrative requirements.
>
> In the case of the self-insured group health plan maintained by your
> hospital for its employees, all of the provisions of the Privacy Rule will
> apply.
>
> However, your hospital and the group health plan may (and probably do)
have
> different compliance dates. The compliance date for health care providers
> is the first date of service after April 14, 2003. The compliance date
for
> health plans (including group health plans) is April 14, 2003 for large
> plans and April 14, 2004 for small plans. A "large plan" is one that has
> "receipts" (i.e., pays premiums in the case of an insured plan or provides
> benefits in the case of a self-insured plan) of $5,000,000 or more
annually.
> A "small plan" is one that has annual receipts of less than $5,000,000.
>
> Hope this helps.
>
> John D'Amato
> redHIPAA.com (coming soon)
>
> ----- Original Message -----
> From: "David Blasi" <[EMAIL PROTECTED]>
> To: "WEDI SNIP Privacy Workgroup List" <[EMAIL PROTECTED]>
> Sent: Thursday, March 13, 2003 3:51 AM
> Subject: Re: Self insured health plans & NPP
>
>
> > Without going into a lot of discussion about the difference between the
> > plan sponsor and plan administrator activities, the plan administrator
> > is responsible for this. If you are also the plan administrator, than
> > you have both responsibilities. Your SPD should state who is the plan
> > administrator for easy reference.
> >
> > >>> <[EMAIL PROTECTED]> 03/13/03 07:40AM >>>
> > We are an acute care hospital providing health insurance to our
> > employees
> > as a self-insured plan. As the plan sponsor we are required to amend
> > our
> > group health plan document to comply with HIPAA. Are we also
> > responsible
> > for drafting and providing to our employees a Notice of Privacy
> > Practice,
> > or is that the responsibility of the health plan?
> >
> > Bonnie R Millman
> > Privacy Coordinator
> > Bayhealth Medical Center
> > 640 South State Street
> > Dover, Delaware 19901
> >
> > 302-744-6728
> >
> >
> >
> > ______________________________________________________________________
> > CONFIDENTIALITY NOTICE: The information contained in this e-mail
> > message
> > and any attachment(s) is intended only for
> > the confidential use of the intended recipient(s) named above. This
> > e-mail message and any attachment(s) may contain
> > confidential health information or other confidential information that
> > is
> > legally privileged and exempt from disclosure under
> > applicable law. If the reader of this e-mail message is not the
> > intended
> > recipient or the employee agent responsible for
> > delivering it to the intended recipient, you should be aware that any
> > dissemination, distribution, copying or action taken in
> > reliance on the content of this e-mail message or any attachment(s)
> > is
> > strictly prohibited. If this e-mail has been received
> > in error, please notify us immediately via e-mail at
> > [EMAIL PROTECTED] and delete or otherwise destroy the
> > original message, any attachment(s) and copies. Thank you for your
> > cooperation.
> >
> >
> > ---
> > 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/. These listservs should not be used for
> > commercial marketing purposes or discussion of specific vendor products
> > and services. They also are not intended to be used as a forum for
> > personal disagreements or unprofessional communication at any time.
> >
> > You are currently subscribed to wedi-privacy as:
> > [EMAIL PROTECTED]
> > To unsubscribe from this list, go to the Subscribe/Unsubscribe form at
> > http://subscribe.wedi.org or send a blank email to
> > [EMAIL PROTECTED]
> > If you need to unsubscribe but your current email address is not the
> > same as the address subscribed to the list, please use the
> > Subscribe/Unsubscribe form at http://subscribe.wedi.org
> >
> >
> >
> > ---
> > 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/. These listservs should not be used for
> commercial marketing purposes or discussion of specific vendor products
and
> services. They also are not intended to be used as a forum for personal
> disagreements or unprofessional communication at any time.
> >
> > You are currently subscribed to wedi-privacy as:
> [EMAIL PROTECTED]
> > To unsubscribe from this list, go to the Subscribe/Unsubscribe form at
> http://subscribe.wedi.org or send a blank email to
> [EMAIL PROTECTED]
> > If you need to unsubscribe but your current email address is not the
same
> as the address subscribed to the list, please use the
Subscribe/Unsubscribe
> form at http://subscribe.wedi.org
>
>
>
> ---
> 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/. These listservs should not be used for
commercial marketing purposes or discussion of specific vendor products and
services. They also are not intended to be used as a forum for personal
disagreements or unprofessional communication at any time.
>
> You are currently subscribed to wedi-privacy as: [EMAIL PROTECTED]
> To unsubscribe from this list, go to the Subscribe/Unsubscribe form at
http://subscribe.wedi.org or send a blank email to
[EMAIL PROTECTED]
> If you need to unsubscribe but your current email address is not the same
as the address subscribed to the list, please use the Subscribe/Unsubscribe
form at http://subscribe.wedi.org
---
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/. These listservs should not be used for
commercial marketing purposes or discussion of specific vendor products and services.
They also are not intended to be used as a forum for personal disagreements or
unprofessional communication at any time.
You are currently subscribed to wedi-privacy as: [EMAIL PROTECTED]
To unsubscribe from this list, go to the Subscribe/Unsubscribe form at
http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED]
If you need to unsubscribe but your current email address is not the same as the
address subscribed to the list, please use the Subscribe/Unsubscribe form at
http://subscribe.wedi.org
