Plan Amendment

[oriecat]

I hope this isn't too stupid of a question... back in April, we did the plan amendment and plan sponsor certification for HIPAA, sent it off to the TPA, thought it was all signed, we were good. They then sent us a whole new plan document with the added sections and a new execution page. I just ignored it, since we'd already signed everything. They now sent a letter saying how we never did the HIPAA stuff and they need it asap or we won't get our reports. So I am faxing copies of the amendment and certification.

If we have a signed amendment is it necessary to recreate the entire plan doc and re-execute it? It seems redundant to me. Is that normal?

[jeanine]

Well, if you do it the way you did it, the TPA wouldn't make any extra money off of HIPAA. Your plan did exactly what we counseled our plans to do--sign the amendments. We didn't even ask for a copy and we certainly did not reissue plans or require them to be re-executed. In lieu of the signed certification, we have been relying on an attachment we added to our ASO agreements several years ago. In the attachment we have the plan state who represents the plan and is allowed access to PHI. I'm curious as to who your TPA is.

[Steve72]

You are right, an amendment is sufficient. THere's no need to restate the entire plan.

Maybe they're talking about a business associate agreement? Did you execute one with the TPA?

[GBurns]

I have seen some TPAs and ASOs take the viewpoint that a Plan amendment requires that the plan document itself be amended hence new or revised PD rather than an addendum or attachment.

With this viewpoint if the old PD is 25 pages long and the new language that needs to be added is 5 pages, the 5 pages must be imbedded within the documents 25 existing pages creating a single document with 30 pages.

The difference is then between imbedding and adding or including versus attaching.

I guess I can see both sides, but I wish that these TPAs and ASOs were not so adamant that their interpretation is the only one allowed.

I solved the problem in some cases by pointing out that they were contractually bound to provide the reports and in a timely manner, giving them a choice of being sued now, with all monies being withheld, or addressing the issue in due course.

[Steve72]

Well, they're correct that the document must be amended. HIPAA is very clear on that. However, ERISA permits documents to be amended without restating the entire plan. There is no argument that I'm aware of that would require the document to be re-published. An amendment adopted in accordance with the procedures established by the plan document itself is sufficient (and necessary).