Dr. Pamela Hymel, MD, MPH, FACOEM, is president of the American College of Occupational and Environmental Medicine.

ACOEM Sounds Alarm on GINA Title II Regs

Dr. Pamela Hymel, the association's president, warned her members that EEOC may conclude wellness programs provided through group health plans are not voluntary if incentives to participate are involved, which could severely restrict their use by employees.

Title II of the Genetic Information Nondiscrimination Act of 2008 (GINA), which applies to private and state and local government employers with 15 or more employees, employment agencies, labor unions, and joint labor-management training programs, takes effect today. And the EEOC is expected to issue new regulations under Title II that could damage employers' use of wellness and disease management plans, Dr. Pamela Hymel, MD, MPH, FACOEM, president of the American College of Occupational and Environmental Medicine, contends in a Nov. 17 letter to EEOC.

In a phone interview Nov. 20, Hymel said ACOEM is working with the Integrated Benefits Institute and the National Business Group on Health to get this message across to EEOC, which posted a release Nov. 20 saying its Title II regulations are already being reviewed at the Office of Management and Budget and will be issued once that review is completed.

Using incentives to encourage employees to participate in wellness programs and complete health risk assessments "is key in many, many employers' strategy right now," Hymel said. "This will cause a very big strategy shift." She also said, "we're not 100 percent sure they [EEOC] understand the impact of what they've written."

The regulations may conclude wellness programs provided through group health plans aren't voluntary if incentives to participate and complete health risk assessments (HRAs) are involved, Hymel wrote. "Wellness, prevention, and disease management programs will improve the health and productivity of individuals and control our soaring healthcare costs. Moreover, these are programs that generally are met with enthusiasm by employees, who are often relieved to have the opportunity to move towards a healthier lifestyle. To make our tasks in this regard more difficult, by preventing the use of financial incentives, is an incomprehensible action in view of the need to hold down medical costs and encourage individuals to participate in programs that help them assume more active control of their health," she wrote.

"As the medical society devoted to promoting the health of workers, we believe strongly in the efficacy of workplace wellness and prevention programs in reducing health care costs and improving worker productivity and we support them as a fundamental component of health reform. Occupational physicians have been committed to the use and expansion of wellness, prevention, and disease management programs for a number of years. These programs address potential health problems of workers, often before they develop into more costly and deadly chronic disease. These efforts to encourage and guide healthy behavior, which have become increasingly popular within workforces, have helped to control health care costs while improving the quality of life for individuals.

"ACOEM is concerned that the definition of a 'voluntary' wellness program in this regulation could severely impair the effectiveness of and participation in these programs in the workplace. Voluntary wellness programs, including incentives for completing a health risk assessment (HRA), can provide significant benefits to the individual. The HRA is a key entry point into employee health and wellness programs. The HRA is a widely used, evidence-based tool to identify individuals with and at risk of chronic conditions and to ensure they receive appropriate and beneficial wellness, prevention and disease management services.

"Many employees need some encouragement to complete a long, detailed HRA and to start participating in a program of healthy living; financial incentives provide a key motivational trigger. Eliminating the employer's ability to provide a financial incentive to individuals who complete an HRA or participate in a wellness program would effectively end these programs and the positive results they have produced for workers. We do not believe that a family medical history, while useful, is necessary to complete an HRA. We believe that incentives should to used to encourage participation in these programs and should not be tied to health status, biometric results or meeting outcomes from health improvement programs."

Hymel addressed a letter to ACOEM's members asking them to fax a similar letter to Stuart J. Ishimaru, EEOC's acting chairman, with copies faxed to Dr. Robert Kocher, special assistant to the president, National Economic Council, at the White House, and Dr. Ezekiel Emanuel, special advisor for Health Policy, Office of the Director, Office of Management and Budget; and a copy sent to Pat O'Connor, ACOEM's director of Government Affairs.

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