HIPAA Small Plan Definition - Dipping Below $5 Million Threshold

[Christine Roberts]

Are there any provisions in HIPAA that relate to plans that dip above or below the $5 million annual receipts/premiums level on a year to year basis, similar to provisions related to the the 100 participant threshhold for Form 5500 filing?

I am unaware of any but am wondering if anyone has some leads on this issue.

Thanks....

[Steve72]

Because the small plan definition is relevant for a one-year extension, you look at the annual receipts for the last full fiscal year before April, 2003.

See here:

http://questions.cms.hhs.gov/cgi-bin/cmshh...ated=1031601197

for information on how to calculate the "annual receipts" of a health plan.

-Edit below-

April, 2003 is the relevant year for the one-year extension of the Privacy Rule. If you are interested in the automatic extension for the transaction standards (and did not file for an extension) the relavant date is October, 2002.

[Christine Roberts]

Thanks for the reply - so is it safe to say that, if the plan DID file for an extension in October, 2002, the relevant plan year for assessing the $5 million dollar threshold is the plan's last full fiscal year ending before October, 2003??

[Steve72]

No. For the transaction standards, the small health plan definition is immaterial if an extension has been filed for.

If the plan wants the additional year for the PRIVACY standards, you should look at the last full fiscal year that ended before April, 2003.