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May 06, 2013 at 10:05 AM
The simmering battle over wellness programs is starting to boil over in California.
Members of the California Senate Health Committee recently voted 5-2 to pass Senate Bill 189, a bill that would put new restrictions on employer-sponsored wellness programs.
The bill, introduced by state Sen. Bill Monning, D-Carmel, would prohibit a wellness program from rewarding participants with a discount or rebate involving a premium, deductible, co-payment or coinsurance amount.
Any wellness program would have to be voluntary and offered to all similarly situated individuals, and a program could not base the receipt of a reward on a health status factor.
A wellness program could provide rewards based on an individual’s membership in a fitness center, an individual’s participation in a diagnostic testing program, or attendance at a periodic health education seminar, as long as the seminar “is not related to a particular health condition or health status factor.”
Monning said RAND Corp. analysts found little evidence on whether wellness programs work or whether they lead to unintended outcomes, such as discrimination against employees “based on their health or health behaviors.”
The bill would apply only to new wellness programs sold after the bill was enacted, not to wellness programs that were already in force.
The provisions in the bill would expire in 2020.
The drafters of the Patient Protection and Affordable Care Act of 2010 (PPACA) sparked a controversy about wellness programs by including a wellness program pricing provision in the rules restricting health carriers’ ability to consider individuals’ health status when setting rates. Under PPACA, carriers cannot consider individuals’ health status when setting rates, but carriers can use incentives related to wellness programs to vary rates by as much as 50 percent.
