2014 US Government Workplace Wellness Regulations: Impacts

The last discussion laid out the nuts and bolts of the final government regulations on corporate wellness programs. They go into effect on the first of the new year, and finalized most of the regulations that were proposed late last year.

Here's a quick review:

  • Wellness programs are split between participatory wellness programs (PWPs) and health-contingent wellness programs (HWPs).
  • There are two types of health-contingent programs: activity-only (AWPs) and outcome-based (OWPs).
  • Participatory programs are largely unchanged from the 2006 regulations.
  • Health-contingent programs have five criteria they must meet in order to fulfill the nondiscrimination rules of HIPAA.
  • The most important criterion for HWPs is likely to be structuring their programs to provide reasonable alternative standards (RAS's) that satisfy the regulatory language and aren't smokescreens for health factor-based discrimination.

The third section of the OFR document speculates on economic, paperwork, and federalism impacts of these regulations. Let's get the easiest part out of the way first.

Paperwork

The final regulations require group health plans and group health insurance issuers to disclose the availability of reasonable alternative standards and waivers in all plan materials that describe the terms of a health-contingent wellness program. (See the overview's section on disclosure for full details.)

If your company already has a wellness program in place, and doesn't plan on making any drastic changes, your paperwork shouldn't change much. Most of the information required at the federal level is already mandated either by typical business practices of health plans and health insurance issuers, or by state or local regulations.

On the flip side, let's say your company doesn't currently have a wellness program in place. Senior management decides to begin a program at the start of 2014. Well, now you'll have some work to do.

Once the nuts and bolts of the proposed wellness program are confirmed, management will have to work with its group health plan / health insurance issuer to change the health plan's summary plan description (SPD) and issue a summary of the material modifications (SMM). Right now, when the materials of a health plan are changed, SPDs must be provided every five years. SMMs, on the other hand, have to be issued within 210 days after the end of the plan year in which the change was adopted. They must also be given to plan participants and beneficiaries by the plan administrator.

This has been the standard process since at least 2000, when the last substantive change to OMB #1210-0039 was made. The new wellness program regulations should not change this process much, if at all.

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2013 US Government Workplace Wellness Regulations: Overview

Today we bring you an overview of the US government's final wellness program regulations (pdf), or "Incentives for Nondiscriminatory Wellness Programs in Group Health Plans" if you want to be official about it, and you'll receive a nice little primer on just how intricate these regulations really are. Don't worry, it shouldn't be too labyrinthine.

The Three Types of Wellness Programs

In the 2006 regulations, there were only two types of wellness programs: participatory and health-contingent. The 2014 regulations now address three types of wellness programs:

  • Participatory wellness programs
  • Activity-only wellness programs
  • Outcome-based wellness programs

They've effectively split health-contingent programs into two subcategories: activity-based and outcome-based.

Participatory wellness programs (PWPs) are pretty much the same as they were in the 2006 regulations. They're also the simplest to understand. These programs don't base their rewards on the eight health factors discussed yesterday. You either qualify for the reward or you don't. Examples include:

  • reimbursing employees for gym memberships,
  • providing a reward to employees who take part in a diagnostic screening program (but with NO REWARD based on the outcomes), and
  • providing a reward to employees who attend a free monthly health education session. 

Participatory programs also don't have to meet the same requirements as health-contingent programs. Really, the main requirement is simply that rewards be available to all similarly situated individuals, regardless of health factors. Some comments were raised about how schedules can affect availability, but HIPAA regulations don't include scheduling limitations as a means to discriminate participants.

As a result, even if an employee's schedule makes it difficult for him/her to participate in this type of program, the wellness program has not violated any HIPAA nondiscrimination rules.

The two health-contingent wellness programs give out rewards based on whether employees satisfy various health factor-related standards. The caveat is that if employees don't satisfy those initial standards, they have to take more action than other similarly situated people in order to receive the reward. It boils down to these two options:

  • performing or completing an activity related to a health factor, or
  • attaining or maintaining a specific health factor.

Activity-only wellness programs (AWPs) fall under the first bullet point. Employees have to perform or complete activities that relate to health factors in order to receive the reward. These programs don't require adhering to certain health outcomes (like weight, cholesterol, or BMI). Your wellness program might be activity-only if it focuses on a walking program, a diet program, or an exercise program, and gives the reward to those who take part.

Outcome-based wellness programs (OWPs) fall under the second bullet point. Employees must reach or maintain a specific health-related guideline in order to qualify for the reward. Common examples include non-smoking protocols and certain results of biometric screenings, like weight, waist circumference, cholesterol, or blood pressure.

Outcome-based programs will typically have two parts. The first part consists of some type of assessment (measurements, screenings, tests) to see if the person meets an initial standard. The second part involves a larger program that seeks to help those employees who don't meet the initial standard. This program, as you might expect, involves different wellness activities.

The tricky thing about activity-only and outcome-based programs is that they must answer these questions:

  1. Do employees have a reasonable chance to qualify for the reward?
  2. Is the reward size in compliance with guidelines?
  3. Is the program reasonably designed?
  4. Are the rewards uniformly available, and are there reasonable alternative standards?
  5. Are the methods for receiving rewards made clear, including reasonable alternative standards?

We'll address each question on base level first, but rest assured that there is plenty of detail yet to be uncovered. There are still almost a hundred more pages to get through!

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Reuters on RAND Workplace Wellness Report: Wellness Fails Bottom Line - Part 2 of 2

The first part of my discussion centered on the RAND report stating that workplace wellness programs don't help a business' bottom line. There were a few elements that irked me, especially the fact that the headline doesn't coincide with the realities exposed in the article.

So many wellness programs fail because they don't do anything. They don't educate. They don't evaluate. They don't improve or change. They don't value employee input. At that point, it becomes something like a potted plant. It's there, it looks nice, it doesn't contribute to anything worthwhile, and the only people to give a damn are the ones already interested in gardening.

Reuters may as well have put out a companion article titled, "Neglected Office Plants Fail To Beautify Workplace."

On the other hand, the Reuters article did highlight some absolute essentials for wellness program success.

"Traditional workplace wellness barely scratches the surface," said Keith Lemer, president of WellNet, which provides programs to Cumulus Media, Viking Range Corp and the Charlie Palmer Group of restaurants, among others. "Done right, (the program) requires the integration of clinical data, wellness, health coaching, and work flow." The initiatives succeed if they have "senior level support and a high-degree of employee engagement in healthy behaviors," he said.

Any of this sound familiar?

Clinical Data

In other words, various measures of health. Waist circumference (BMI isn't reliable for individuals), age, weight, and I guess you can collect things like pulse rates, blood pressure, and cholesterol if you really want to. I'd stick with fewer metrics on the clinical side, though, because you're not operating a doctor's office. You're operating a wellness program. Age, weight, and waist circumference are all good metrics. Blood pressure and pulse rate seem good at an intuitive level, but both are things I have to explore a bit more in depth.

Wellness 

This seems a bit vague, but makes sense. When I put it in context with the rest of the quote, I see an emphasis on lower stress, better nutrition at work and at home, physical activity during the work day, and a focus on preventive measures for health instead of reactive ones (like medicine and doctor visits).

This is definitely one of those areas that relies a lot on the company culture. If your entire organization doesn't but whole-hog into wellness, you're in for a rough ride.

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Reuters on RAND Workplace Wellness Report: Wellness Fails Bottom Line - Part 1 of 2

I say they're full of it.

Reading between the lines of this article, it seems to me that most of the wellness programs surveyed are cookie-cutter McPrograms that don't actually offer much of anything worth a damn. Smoking cessation programs are mentioned, and I would suspect that a handful of weight-loss efforts are promoted, but it simply doesn't appear to me that much education is being done.

The issue with most wellness programs is employee motivation, as Al Lewis (of Disease Management Procurement Consortium International) correctly states. A lot of people simply aren't motivated to lose the weight. Either that or they want the easiest solution possible - preferably a pill or magic wand being waved over their bodies.

I will bet fifty thousand dollars that at least 75% of the 600 wellness programs surveyed don't do an adequate job of getting employee input.

You know what happens when you get good employee input? You discover their motives. Why do they want to get healthy? What would motivate them to do the work necessary to eat healthy and be active?

You also discover their weaknesses. What is their biggest obstacle to becoming healthy? (Ten more bucks says they think it's "too hard.") What other obstacles do they face? What don't they know about nutrition or activity, and how each affects the body?

You also discover their fears, their stressors, and their "carrots." What are they afraid of? What puts them on edge, makes them worry, and keeps them up at night: about work, about their health, about their kids'/spouse's health? What are the ways you could get them to take a vested interest in bettering themselves and their families?

All of this has a huge impact on the success of your wellness program. Armed with all this information, you can tailor the program to your office. You can place incentives that get employees excited about improving their health. You can structure nutrition education seminars to improve your employees' knowledge about how different foods affect their bodies - whether positively or negatively. You can create cookbooks for quick, healthy recipes, since so many full-time workers today claim they have such little time to cook healthful meals.

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HR & Wellness "Tweets of the Week" #3

Busy week? Ready to kick back for a long Memorial Day weekend? Looking for a way to kill the last couple hours before heading out early? (It's ok, we won't tell.) Check out the latest selection of top tweets from the last week below.

Top tweets?

These are just a collection of tweets we thought deserved to be noted, highlighted, saved, etc. Some might just be funny. Others might include links to great articles, but might not make our weekly, HR & Wellness Links Worthy OF Your Attention series. You never know what you might find, and that's the fun of it! Enjoy!

 

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