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Wellsource Blog

Impact of the Health Care Reform Laws on Wellness Programs

Written by Wellsource, Inc.

April 22, 2010

The Patient Protection and Affordable Care Act, signed into law on March 23, 2010, and the amendments contained in the Health Care and Education Reconciliation Act of 2010 (collectively, the "Health Care Reform Laws"), provide significant funding for wellness initiatives for both the private and government sectors. A few of the new programs pertinent to Wellsource clients are summarized below.

Wellness Grants for Small Business

Small businesses (less than 100 employees) that did not have a wellness program in place prior to the enactment of the Health Care Reform Laws will be eligible for a federal grant to establish a wellness program. To qualify for the grant, the wellness program must be comprehensive and contain at least the following components:

  • Health awareness initiatives, including health education, preventive screenings, and health risk assessments.
  • Efforts to maximize employee engagement and mechanisms to encourage employee participation, such as financial incentives.
  • Initiatives to change unhealthy behaviors and lifestyle choices, which may include coaching or counseling, seminars, online intervention programs, and self-help educational materials.
  • Supportive environmental efforts, including workplace policies to encourage healthy lifestyles, healthy eating, increased physical activity, and improved mental health.

The grants, which begin in 2011, will be available through the U.S. Department of Health and Human Services (HHS). The HHS Secretary will be issuing protocols later this year on the application process and (presumably) how much will be available per employer. So far, $200 million has been allocated in the federal budget for this program.

To learn more about how to put together a comprehensive worksite wellness program using Wellsource® tools that meets the wellness grant guidelines, contact your Regional Manager of Business Development today.

Technical Assistance for Employers

The Centers for Disease Control and Prevention (CDC) will begin offering technical assistance to employers (regardless of size) to train staff on how to evaluate their existing wellness program. Such assistance will include offering evaluation resources and consultation through web portals and call centers. Evaluation criteria will include the following:

  • Measuring the participation and methods to increase participation of employees in such programs.
  • Developing standardized measures that assess policy, environmental and systems changes necessary to have a positive health impact on employees' health behaviors, health outcomes, and health care expenditures.
  • Evaluating the effectiveness of the employer's wellness program by looking at
    changes in the health status of employees, the absenteeism of employees, the productivity of employees, the rate of workplace injury, and the medical costs incurred by employees.

It's unclear when this new resource will become available to employers, but what is clear is that the government's prevention plan includes significant support for corporate wellness programs.

Greater Employee Rewards for Meeting Health Standards

The Health Care Reform Laws increase the amount that employers may reward employees for meeting specific health standards. The current HIPAA nondiscrimination rules for wellness programs limit such rewards to no more than 20 percent of the cost of employee coverage under the group health plan. But starting January 1, 2014, employers will be permitted to offer employees rewards for participating in a wellness program and meeting certain health standards – in the form of premium discounts, waivers of cost-sharing requirements, or benefits that would not otherwise be provided – of up to 30 percent of the cost of their health insurance coverage. Moreover, the reward limit may be increased to 50 percent of the cost of coverage at a future date, if deemed appropriate by the Secretaries of HHS, Treasury and the Department of Labor. In accordance with existing law, employers will still be required to offer an alternative standard (or waive the requirement) if it would be unreasonably difficult or inadvisable (based on doctor's recommendation) for an employee to meet the established standard.

Health Plans Required to Implement Wellness and Health Promotion Activities

By March 2012, group health plans (including employer-sponsored plans) and health insurance issuers will be required to implement wellness and health promotion activities for enrollees under the plan. This "may include personalized wellness and prevention services which are coordinated, maintained or delivered by a health care provider, a wellness and prevention plan manager, or a health, wellness or prevention services organization that conducts health risk assessments or offers ongoing face-to-face, telephonic or web-based intervention efforts for each of the program's participants." H.R. 3590 Sec. 2717(b). Activities and services in the following wellness areas are suggested:

  • Smoking cessation
  • Weight management
  • Stress management
  • Physical fitness
  • Nutrition
  • Heart disease prevention
  • Healthy lifestyle support
  • Diabetes prevention

Contact your Regional Manager of Business Development for more information about the educational resources Wellsource offers on the above topics.

National Prevention Strategy and Prevention Fund

To develop and promote a national strategy for improving the nation's health, the Health Care Reform Laws provide for the creation of a National Prevention, Health Promotion and Public Health Council comprised of the HHS Secretary and other federal department heads. The Council is tasked with providing recommendations to the President and Congress concerning the most pressing health issues confronting the United States and changes in federal policy to achieve national wellness, health promotion, and public health goals, including the reduction of tobacco use, sedentary behavior, and poor nutrition. The Council's first report is due by July 1, 2010.

A Prevention and Public Health Fund is also created to expand and sustain funding for prevention and public health programs. The Fund will grow from $500 million in 2010 to $2 billion annually by 2015.

Grant Programs for State and Local Governments and Nonprofits

Community Transformation Grants will also be available from the CDC for state and local governments, national community-based organizations, nonprofit organizations, and Indian tribes to support the delivery of evidence-based and community-based prevention and wellness services aimed at strengthening prevention activities and reducing chronic disease rates. Among other authorized uses, the funds may be used for creating healthier school environments, developing community events to increase access to nutrition, physical activity and smoking cessation programs, implementing worksite wellness programs and incentives, and working to highlight healthy options at restaurants and other food venues. These grant funds are appropriated for five years beginning in 2010.

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"Good health is your greatest asset. You will never regret a decision to take better care of your health."

Don Hall, DrPH, CHES, Founder Wellsource

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