During a recent policy briefing, Patrick O’Connor, director of public affairs for the American College of Occupational and Environmental Medicine (ACOEM), presented the following summary of healthcare reform law provisions the college believes will be particularly relevant to OEM physicians:
Wellness Incentives (Sec. 1201) – Codifies HIPAA regulations:
Wellness programs that do not require an individual to satisfy a standard related to a health factor as a condition for obtaining a reward for participation would not violate the Health Insurance Portability and Accountability Act (HIPAA) as long as participation in the program is non-exclusive.
Wellness programs with conditions for obtaining a reward that are based on an individual meeting a certain standard relating to a health factor would have to comply with additional requirements. Rewards must be capped at 30 percent of the cost of the employee-only coverage under the plan (instead of 20 percent under existing regulations), with the discretion to increase the reward up to 50 percent.
The federal government will establish a 10-state pilot program that will apply wellness program provisions to health insurers in the individual market.
Wellness and Health Promotion (Sec. 1201):
Requires the Secretary of Health and Human Services (HHS) to develop reporting requirements for group health plans and health insurance issuers with respect to plan or coverage benefits and provider reimbursement models that implement “wellness and health promotion activities.” These may include personalized wellness and prevention services that 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.
Coverage of Preventive Health Services (Sec. 2713):
Stipulates that a group health plan and a health insurance issuer offering group or individual health insurance coverage shall not impose any cost-sharing requirements for:
• Evidence-based items or services that have a rating of “A” or “B” in U.S. Preventive Services Task Force recommendations.
• Immunizations recommended for specific individuals by the Advisory Committee on Immunization Practices.
National Prevention, Health Promotion and Public Health (Sec. 4001):
Council: Creates a council with HHS to provide coordination and leadership on prevention, wellness, and health promotion practices, the public health system, and integrative healthcare in the U.S. and to develop the National Prevention Strategy. The council will be comprised of departmental secretaries in the federal government; the surgeon general will act as chair.
Advisory Group: The president will appoint an Advisory Group to the National Prevention, Health Promotion and Public Health Council. The group will include licensed health professionals, including practitioners with expertise in worksite health promotion and preventive medicine.
Strategy: Directs the council to create a national strategy for prevention and health promotion.
Prevention and Public Health Fund (Sec. 4002): Establishes a fund to provide for an expanded and sustained national investment in prevention and public health programs.
Employer-Based Wellness Programs (Sec. 4303): Directs the Centers for Disease Control and Prevention to provide employers with technical assistance, consultation, and tools to evaluate wellness programs and build evaluation capacity among workplace staff. Any information generated by these programs may not be used to mandate requirements for workplace wellness programs.
Small Business Grants (Sec. 10408): Directs HHS to award grants to small businesses to give employees access to comprehensive workplace wellness programs.
Federal Health and Wellness Initiatives (Sec. 4402): Requires HHS to evaluate federal initiatives and report to Congress on their status.
Training Grants: Directs HHS to award grants to or enter into contracts with eligible entities to provide training to graduate medical residents in preventive medicine specialties.
