Wellness Program - HIPAA Privacy

[DTH]

We have certain employees that may need some physical therapy to remain healthy to do their job. The employer pays for and provides the services of a chiropractor and physical therapist on site and a nutritionist off site. Any employee in the department may utilize these services.

Is this an ERISA plan? What type of plan would you consider this? Does HIPAA Privacy apply?

[Steve72]

On-site medical cliincs are not health plans for purposes of HIPAA. However, if they conduct "covered transactions" in an electronic amnner (e.g., billing for services), they may be covered providers, which are subject to HIPAA. This is a very fact-specific analysis, and you probably need more detailed review than it is possible to get on a message board.

As for the off-site nutritionist, does the employer (or the plan) directly pay the nutritionist, or is it reimbursement? If it is a reimbursement program, there is an argument that it is not a health plan for HIPAA purposes. However, if the program actually receives claims from the provider, it is most likely subject to HIPAA.

[DTH]

Thanks Steve. There are two service providers on-site who are paid by the employer on an annual retainer. There is one service provider on-site that is paid by the employer per hour while on site no matter if any employee is seen. The off-site nutritionist is paid directly by employer only when the employer sends an employee to the nutritionist. If the employee goes to the nutritionist on his/her own, the health plan pays through the normal claims process.

Based on your e-mail it appears that the services provided on-site could be treated as an on-site medical clinic, thus not subject to ERISA or HIPAA. I thought that the ERISA exception for on-site medical clinics is only where it was for emergencies, flu shots etc.???