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Wellness Program Regulations Proposed

At first glance, the new HIPAA-based guidelines seem like a serious blow to incentives.

January 31, 2001
Related Topics: Miscellaneous Legal Issues, Health and Wellness
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ellnessprogram incentives could run into a chill factor from proposed HIPAA regulationspublished in the Federal Register on Jan. 8, 2001. Wellness programs would haveto meet certain standards, including accommodations for health limitations.

   “If it is unreasonably difficult for an individual to stop smoking due to anaddiction to nicotine, the individual must be provided a reasonable alternativestandard to obtain the reward,” according to the HIPAA regulations.

   At first glance, this seems like a serious blow to incentives. When smokingcessation is watered down to something like a walking program, isn’t thehealth risk still present? Won’t the employer’s cost of medical claimsremain essentially the same? And if claims cost stays high, hasn’t thefinancial basis for providing incentives been seriously undermined?

   But the wellness environment may not be quite that simple, says Diana Frantz,R.N., health and wellness director for Murata Electronics.

   Frantz commented on the smoking example before seeing the full draftregulations. “You may have five (health risk) areas you need to work on. Aslong as you’re working on one of those, we’re still going to reward you.We’re working in more general terms anyway, because it’s really tough toreward people based on a very specific goal. You can set people up to fail ifyou say, ‘you have to drop your cholesterol by 100 points to get thisincentive.’ To me, it’s enough to know they want to make change andthey’re taking some steps to get there.”

   Keith Rye, chief operations officer for Gordian Health, noted the regulation“should encourage employers to use third-party vendors” to insulatethemselves from potential liability issues like the one described in the smokingexample.

   Wellness professionals and other affected parties in HR should visit the Jan.8 Federal Register, scroll down to Health Care Financing Administration, anddownload a copy of the proposed bona fide wellness programsrules. You may register your comments with the listed agencies on or beforeApril 9, 2001.

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