DDES Memo Series
2003-03
April 28, 2003
STATE OF WISCONSIN
Department of Health and Family Services
Division of Disability and Elder Services
To:
Area Administrators/Assistant Area Administrators
Bureau Directors
CIP 1A Contacts
COP County Contacts
COP Fiscal Contacts
COP Waiver Contacts
County Departments of Community Programs Directors
County Departments of Developmental Disabilities
Services Directors
County Departments of Human Services Directors
County Departments of Social Services Directors
County Mental Health/AODA Coordinators
County Primary DD Contact
County/Tribal Aging Unit Directors
CSLA County Contacts
Licensing Chiefs/Section Chiefs
Tribal Chairpersons/Human Services Facilitators
From:
Sinikka McCabe,
Administrator
Re: HIPAA HEALTH PLAN STATUS FOR THE COMMUNITY OPTIONS PROGRAM
Document Summary
This memo clarifies the Department of Health and Family Services’
(DHFS) position on the Community Options Program (COP- Regular) health
plan status under the Health Insurance Portability and Accountability Act
of 1996 (HIPAA). This clarification applies to the health plan references
made in both DSL Info Memo 2002-12 and DSL Memo Series 2002-23. DHFS has
determined that the COP program is not a health plan under HIPAA. This
program is no longer bound by the Business Associate Agreement addendum to
the 2003 State and County Contract. Counties should comprehend this change
when making HIPAA related health care component designations.
Background
As required by HIPAA, the 2003 State and County Contract includes a
Business Associate Agreement covering situations where the counties are
performing specific functions on behalf of DHFS programs that have been
determined to be Health Plans and covered by HIPAA. The programs covered
by this agreement are listed as follows:
- Brain Injury Waiver
- Community Integration Program (CIP-IA)
- Community Integration Program (CIP-IB)
- Community Option Program (COP)
- Medicaid Community Waivers (CIP II/COP-W).
The COP program was included in this agreement because it was
determined that administrative separation from Medicaid Home and Community
Based Waiver programs was impractical and that the best course was to
treat regular COP as a health plan under HIPAA. Further analysis of DHFS
administration of these programs has now concluded that administrative
separation can be implemented within DHFS. This may also be the case for
counties. The regular COP program was reassessed based upon the services
it pays for instead of the operational linking with the Medicaid Home and
Community Based Waiver programs. It was reaffirmed that the regular COP
program’s principal purpose is other than providing or paying the cost
of health care. This excludes the program from consideration as a health
plan under HIPAA (45 CFR Part 160 s.160.103).
As a result, the regular COP program is no longer bound by the Business
Associate Agreement addendum to the 2003 State and County Contract. This
decision provides each county with some additional flexibility in defining
its health care component boundaries according to what is best suited to
its structure and operations. COP program administrative functions do not
have to be included in an agency’s health care component(s). It may
choose to do so, however, depending upon structure and staff utilization
REGIONAL OFFICE CONTACT:
Area Administrator
CENTRAL OFFICE CONTACT:
Irene Anderson
(608) 266-3884
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