APHA Backs Fully Voluntary Workplace Wellness Programs

The association's executive director submitted comments to HHS that say workers who choose not to participate should not be penalized.

The American Public Health Association submitted comments to the Department of Health and Human Services on Jan. 25 on a rule in the Affordable Care Act that provides discounts to workplace wellness programs to employees if they meet health and fitness benchmarks, such as cholesterol and body mass index (BMI).

The law raises the maximum reward for participating in certain employer-based wellness programs from 20 to 30 percent of the cost of coverage and up to 50 percent for participating in tobacco cessation programs.

"We have some concerns about incentives that alter employees' costs of health insurance, and while we appreciate the effort made in this proposed regulation to offer more clarity on these and other incentive programs, we believe further clarifications are needed, as well as a commitment to evaluation of such programs," wrote Dr. Georges Benjamin, APHA's executive director, in a letter sent to HHS.

APHA expressed support for raising the maximum 50 percent discount for participation in tobacco cessation programs but asked for clarification on how quickly employees will receive their reward after qualifying for it.

The letter says the reasonable design standard should be that the wellness programs are truly voluntary, and that employees who choose not to participate will not be subject to any penalties as a result. "For example, if the program requires employees to take a BMI test, and imposes surcharges on people unless they achieve a certain score or participate in certain activities aimed at improving their scores, employees should have the right to opt out of the program altogether, without incurring the penalty simply for not having taken the test. Wellness is an important goal, and ideally everyone would want to participate, but without protection of people's right to opt out, such a program would effectively be a subterfuge for discrimination based on a health factor. We agree that employers should have some flexibility to innovate, but we believe that evidence- or practice-based standards should be specified as a requirement for reasonable design. One example of such standards is found in a recent Joint Consensus Statement published in the Journal of Occupational and Environmental Medicine, "Guidance for a Reasonably Designed, Employer-Sponsored Wellness Program Using Outcome-Based Incentives," he wrote. (The statement was published in July 2012 and is available here.

The Affordable Care Act rule would be effective for plan years starting on or after Jan. 1, 2014. Visit http://www.healthcare.gov/news/factsheets/2012/11/wellness11202012a.html for more information.

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