Trump Administration Announces Opportunity for States to Participate in Wellness Program Demonstration Project
Bulletin empowers 10 states to provide residents with broader access to wellness programs
Today, the Centers for Medicare & Medicaid Services (CMS), released an informational bulletin announcing the opportunity for 10 states to apply to participate in a wellness program demonstration project for their individual market. This bulletin gives states and issuers new flexibility to design and offer wellness programs for individual market health plans that provide people with direct incentives to make healthier choices and achieve better health outcomes.
Under this demonstration project, participating states may permit a broader range of wellness programs for those in the individual market than are currently available under the law. States will be able to develop innovative ideas to improve their residents’ health by permitting issuers to offer premium cost savings or other incentives for people if they choose to engage in healthy activities and improve their health outcomes through “health-contingent” wellness programs. While rewards may be offered to enrollees who meet certain health standards, participating states must ensure that a reasonable alternative is offered to people who cannot achieve the wellness program standard because of a medical condition, including a pre-existing condition.
“Today’s announcement is another example of President Trump’s commitment to driving better health outcomes by offering states new flexibility to innovate and empower Americans to make the best healthcare decisions for themselves and their families,” said CMS Administrator Seema Verma. “Allowing states to implement these wellness programs in their individual markets offers the opportunity to not only improve the health of their residents but also to help reduce healthcare spending.”
Employers have long offered their employees health-contingent wellness programs. However, these kinds of wellness programs have been unavailable to consumers who purchase coverage in the individual market until now because Obamacare does not allow individual market health-contingent wellness programs outside of this demonstration project. Any state applying to participate in the wellness program demonstration project must clearly show that its program will not result in any decrease in coverage or increase in cost to the Federal Government in providing financial subsidies through the Exchanges. States must also ensure that their wellness programs do not discriminate based on health status.
States will be required to submit data regarding the number of participants, rewards provided, overall issuer cost savings, and changes in participant behavior and utilization or medical claims costs starting three years from receiving approval to participate and annually thereafter. HHS, in collaboration with the Departments of Labor and the Treasury, will review this data to evaluate the wellness program demonstration project and determine whether to expand the demonstration project to permit additional states to participate in the future.
To view the bulletin, please visit: https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/Wellness-Program-Demonstration-Project-Bulletin.pdf