As one Obama administration agency made headlines Thursday by blessing wellness incentives, other regulators were quietly telling employers and insurers to restrain themselves.
The Equal Employment Opportunity Commission (EEOC) said employers can offer wellness incentives with a value equal to 30 percent of the health benefits package. Earlier, the EEOC had gone to court to object to what many benefits industry players viewed as ordinary, plain vanilla wellness programs.
But the U.S. Department of Labor, the U.S. Department of Health and Human Services (HHS), and the U.S. Treasury Department said in a collection of answers to frequently asked questions (FAQs) about the Patient Protection and Affordable Care Act (PPACA) — PPACA FAQs Part XXV — that any wellness programs must be designed to promote better enrollee behavior, not to discriminate against high-risk individuals, or high-risk group health prospects.
The Centers for Medicare & Medicaid Services (CMS) also posted a separate set of FAQ answers of its own on the wellness incentive issue.
The departments note in the introduction to their FAQs that PPACA requires a “health-contingent wellness program” to be “reasonably designed to promote health or prevent a disease.” A program “designed to dissuade or discourage enrollment in the plan or program by individuals who are sick or potentially have high claims experience will not be considered reasonably designed,” the departments say.
For a look at provisions that could attract the wrong kind of regulator attention, read on.
1. Making employees fill out long personal health information questionnaires without doing much to help them stop smoking or lose weight.
The departments say the amount of information a program collects has to have some correlation with the amount of help a program gives enrollees with losing weight, giving up tobacco use, or engaging in some other healthy behavior.
Otherwise, the program will flunk a PPACA rule that requires a health-contingent wellness program to have a reasonable chance of improving the enrollees’ health, the departments say.