EEOC Releases Proposed Regulations on Wellness Incentives

For Immediate Release

 

On Thursday, April 16 the Equal Employment Opportunity Commission (EEOC) released proposed regulations on incentives under employer wellness programs. 

The proposed rule clarifies that an employer may offer limited incentives up to a maximum of 30% of the total cost of employee-only coverage, whether in the form of a reward or penalty, to promote an employee’s participation in a wellness program that includes disability-related inquiries or medical examinations as long as participation is voluntary.  Voluntary means that a covered entity: (1) does not require employees to participate; (2) does not deny coverage under any of its group health plans or particular benefits packages within a group health plan for non-participation or limit the extent of such coverage (except pursuant to allowed incentives); and (3) does not take any adverse employment action or retaliate against employees.

The proposed rule re-asserts the EEOC’s position, based on the language of the Americans with Disabilities Act (ADA), that employee health programs that include disability-related inquiries or medical examinations (including inquiries or medical examinations that are part of an HRA or medical history) must be voluntary and clarifies the application of that rule in light of the amendments made to HIPAA by the Affordable Care Act.

 The EEOC’s proposed rule differs from HIPAA’s wellness program incentives only in that it extends the 30% limit on incentives under health-contingent wellness programs to participatory wellness programs, and applies the limit based on the total cost of employee-only coverage. 

 The EEOC has also published a Fact Sheet for Small Businesses (http://www.eeoc.gov/laws/regulations/facts_nprm_wellness.cfm) and a Q&A Document for the general public (http://www.eeoc.gov/laws/regulations/qanda_nprm_wellness.cfm). 

 We are reviewing the proposed regulations and will release additional commentary in the coming days.

 

Supreme Court Rules on ACA

U.S. Supreme Court Rules on Healthcare Reform Laws

Yesterday, the United States Supreme Court addressed the constitutionality of the Patient Protection and Affordable Care Act (ACA). Of particular interest were the individual mandate and the Medicaid expansion.

The Court held that the individual mandate is constitutional, but that the “failure to comply” penalty provision of the Medicaid expansion is not constitutional. Beyond the Medicaid expansion, the Court’s decision leaves the ACA, including all provisions applicable to insurers and health plan, fully intact.

Below are the issues that the Court heard, followed by the majority decision on each issue:

Issue 1: Is the individual mandate constitutional?
Decision 1: Yes. The individual mandate may be upheld within Congress’ power under the Taxing Clause. It is constitutional to charge a penalty/tax to individuals who do not carry insurance.

Issue 2: Can Congress require states to expand Medicaid eligibility as a condition of receiving any federal funding for their existing Medicaid programs?
Decision 2: No, the Federal Government may not withdraw funds for existing Medicaid programs for failure to comply with the expansion requirement. However, the funds written into the ACA for expansion are still available on a state-by-state basis, per the state’s choice.

Issue 3: Does the ruling affect other provisions of the ACA (a.k.a. the “severability” issue)?
Decision 3: No. The rest of the Act remains intact.

Issue 4: Is suit barred at this time by the Tax Anti-Injunction Act?
Decision 4: No. The ACA does not require that the penalty for failing to comply with the individual mandate be treated as a tax for purposes of the Anti-Injunction Act. The Anti-Injunction Act therefore does not apply to this suit.

LifeWell Health Plans will continue to support its clients’ compliance implementation efforts, given that the ACA provisions will remain inforce. The decision does not impact our commitment to providing quality, affordable, accessible health care or to improving the health of our members.

We will continue our focus on compliance with the law. We have dedicated associates and will ensure that all of our clients’ health plans are in compliance. We have been, and continue to be, ready to meet the requirements of the law and the challenges ahead in our health care system. We are committed to working with our clients and other stakeholders to find solutions that will make our health care system work better for everyone.

YourCare Health and Wellness Program Wins Case in Point Platinum Award

YourCare, offered by LifeWell through its TPA partner, CoreSource, a leading third-party administrator, has been recognized as one of the most successful and innovative case management programs in the country by the second annual Case in Point Platinum Awards program. YourCare was named the winner of a Case in Point Platinum Award in the program’s Safety and Quality Management Program category, recognized for ensuring care to patients with safe, effective, evidence-based care.

“This award provides outside validation that YourCare’s method of encouraging compliance with evidence-based standards of care is making a real difference for our members and clients,” said Donna Heiser, Vice President, Healthcare Management, CoreSource. “We get great feedback from our members about how much our program has helped them achieve their health goals, but formal recognition from the Case in Point Platinum Awards program means the marketplace will gain greater awareness of our program’s effectiveness.”

YourCare has demonstrated success in quality management with increased compliance, better health outcomes for participants, lower costs for employers and improved health for entire employee populations. YourCare provides employers with an estimated return on investment of 2.3 to 1.

CoreSource received the award during the May 10 Case In Point Platinum Awards Luncheon, which was held at the National Press Club in Washington, D.C. The awards program is sponsored by Health, a leading publisher of healthcare business information, including Case In Point, Case In Point Weekly and the Case Management Resource Guide.

YourCare was introduced in 2007 to maximize the health of all members, particularly high-risk members with one or more chronic conditions, while minimizing employers’ healthcare spending. Through YourCare, members with chronic conditions who are not following evidence-based standards of care are notified about “gaps” in their care and encouraged to make an appointment with their doctor. Members who are overdue for important preventive tests get friendly reminders.

The program goes beyond traditional disease management by identifying high-risk employees for targeted interventions even before large costs are incurred. Registered Nurses reach out to help high-risk members get back on track before serious illness arises and healthcare bills skyrocket. They also empower patients to learn and understand their care and prepare them with questions to ask their doctor.

“With our population health management program, members with chronic conditions are complying more with recommended guidelines for care, they’re getting the preventive tests and screenings they need, and they’re talking to their doctor more,” Heiser said. “As a result, employers are gaining more control over their healthcare spending.”

About CoreSource

LifeWell’s partner for claims administration and utilization management, CoreSource is one of the nation’s leading TPAs, delivering integrated, customized employee benefit solutions to self-funded employers. CoreSource is a subsidiary of Trustmark Mutual Holding Company. Trustmark has assets of more than $1.7 billion and, through CoreSource and other subsidiaries, administers more than $2.5 billion in health and life benefits annually.