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Covered Entity (HIPAA)

HIPAA's regulations directly cover three basic groups of individual or corporate entities: health plans, health care providers, and health care clearinghouses.

Health Plan

Fairfax County Government's Health Plan is a separate legal entity and a covered entity under HIPAA. Many of the implementation provisions of HIPAA do not apply to Fairfax County's fully-insured components of the Health Plan; however, all provisions of HIPAA apply to the self-insured component of the Health Plan.

Fairfax County Government employees may participate in the many benefit plans offered by the County, such as health insurance, long term care insurance, the employee assistance program, and flexible spending programs. Fairfax County Government retirees are eligible to continue their health, dental, life, and long-term care insurance. HIPAA applies to these benefit plans, therefore the County benefit plans will be HIPAA compliant. Employees who request assistance from the Department of Human Resources with respect to benefit claims or issues may be asked to sign a waiver, authorizing County benefit staff to discuss their benefit issues with a plan provider. Waivers are available from each individual health plan.

Health Care Provider

Fairfax County Government provides care and services related to the physical or mental health of our residents. Fairfax County also provides numerous non-health care related services to our residents. Fairfax County has chosen to restrict the application of the HIPAA Privacy Rule to those parts of the County enterprise that are performing covered health care transactions. A covered health care transaction is an electronic billing function related to payment or authorization for health care services. The application of the HIPAA Privacy Rule to certain components of the County is permissible within the definition of a hybrid entity.

Fairfax County's hybrid entity currently consists of the Fire and Rescue Department (FRD), the Health Department (HD) and the Fairfax-Falls Church Community Services Board (CSB). Agencies providing human services support to clients of the HD and the CSB will be designated within the hybrid entity as appropriate policies and procedures are adopted. In addition, as agencies seek to automate business processes related to health care billing and electronic transactions, then they will be designated within the Fairfax County Government's HIPAA hybrid entity.

Agencies providing other health care services to employees, students, inmates or residents will continue to apply the appropriate confidentiality provisions mandated by licensure standards, ethical codes, county personnel policies, and other federal and state laws.

Health Care Clearinghouse

Fairfax County Government does not consist of any health care clearinghouse functions.

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