Department of Health Services Logo

 

Wisconsin Department of Health Services

Information memos

Numbered memos

Subscribe for email notification of each new memo

 

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’ (DHS ) 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. DHS 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 DHS programs that have been determined to be Health Plans and covered by HIPAA. The programs covered by this agreement are listed as follows:

    1. Brain Injury Waiver
    2. Community Integration Program (CIP-IA)
    3. Community Integration Program (CIP-IB)
    4. Community Option Program (COP)
    5. 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 DHS administration of these programs has now concluded that administrative separation can be implemented within DHS . 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

 Return to Numbered Memos Index