Just Released: Final Rule on Incentives for Nondiscriminatory Wellness Programs in Group Health Plans

After a long wait, on May 29, the agencies released the final rule on Incentives for Nondiscriminatory Wellness Programs in Group Health Plans is a must read and essential for all population health and wellness industry stakeholders.

The rule was issued by the Internal Revenue Service, Department of the Treasury; Employee Benefits Security Administration, Department of Labor; Centers for Medicare & Medicaid Services, Department of Health and Human Services.

Victoria Shapiro, Care Continuum Alliance Government Affairs Director wanted to share our initial impression review of the rule´s impact for CCA members and the industry as a whole.

In its formal comments on the proposed version of this rule, CCA asked HHS to:

  • Maintain flexibility in the core features of a “reasonably designed” wellness program.
  • Allow for program innovation to create new evidence on wellness strategies for specific populations.

The final rule expressly used this language and granted both of these requests. CCA is also cited in the language of the final rule:

“Currently, insufficient broad-based evidence makes it difficult to definitively assess the impact of workplace wellness on health outcomes and cost; however, available evidence suggests that wellness programs may have some effect on improving health outcomes. The RAND Corporation’s analysis of the Care Continuum Alliance (CCA) database found statistically significant and clinically meaningful improvements in exercise frequency, smoking behavior, and weight control between wellness program participants and non-participants.”

The Departments anticipate that future sub-regulatory guidance may be needed to further clarify portions of this final rule, and will issue such guidance as necessary.

Some Key Points about the Final Rule

  • Clarifies the scope of HIPAA and the Affordable Care Act rules governing wellness programs.
  • Outlines criteria for “an affirmative defense that can be used by plans and issuers” in a claim regarding compliance with HIPAA provisions.
  • Offers detailed steps a plan or issuer can take to ensure wellness programs are reasonably designed and also what constitutes a “reasonable alternative standard”.

Last Thought

The language of the rule reads:

“These final regulations continue to provide plans and issuers flexibility and encourage innovation.”

Final rule on Incentives for Nondiscriminatory Wellness Programs in Group Health Plans

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