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May 29, 2013 at 09:30 AM
Federal agencies said they have tried to take a moderate approach to setting standards for group health plan wellness incentive programs.
Some groups have asked the agencies to make wellness program rules as flexible as possible.
Other groups want the agencies to make insurers base any incentive programs on standards set by bodies such as the Centers for Disease Control and Prevention (CDC), the National Institutes of Health or formal accreditation organizations.
The federal agencies — the Internal Revenue Service (IRS), the Employee Benefits Security Administration (EBSA) and the U.S. Department of Health and Human Services (HHS) — said today they will compromise by requiring wellness incentive programs to use a “reasonable design.”
“These final regulations state that a wellness program is reasonably designed if it has a reasonable chance of improving the health of, or preventing disease in, participating individuals, and is not overly burdensome, is not a subterfuge for discrimination based on a health factor, and is not highly suspect in the method chosen to promote health or prevent disease,” agency officials said in a preamble to the final rule, Incentives for Nondiscriminatory Wellness Programs in Group Health Plans (CMS-9979-F) (RIN 0938-AR48).
The regulations are set to appear in the Federal Register Friday and take effect 60 days after the official Federal Register publication date.
Regulators will decide whether a wellness incentive program is reasonably designed is based on consideration of all the relevant facts and circumstances, officials said.
But regulators may be more likely to accept a wellness incentive program if it is accredited or based on widely accepted clinical standards, officials said.
The IRS, EBSA and HHS developed the new group wellness program standards to implement Section 1201 of the Patient Protection and Affordable Care Act (PPACA). PPACA Section 1201 lets group health plans offer wellness programs, but it prohibits plans from using the programs to discriminate against people with health problems.
Officials noted in a discussion of group health plan wellness program regulations that the PPACA Section 1201 wellness program antidiscrimination rules apply mainly to “health-contingent” programs, or programs that tie financial incentives, such as premium discounts, to weight loss, actual avoidance of tobacco, and other changes in health factors.
