Ten states will be allowed to apply to participate in a wellness program demonstration project for their individual health insurance market, CMS announced in a bulletin.
The wellness programs would provide people with “direct incentives to make healthier choices and achieve better health outcomes,” the announcement reads. In other words, CMS wants to offer cheaper health insurance options to those who lead healthier lives. The agency may be taking a note from employers that offer wellness programs to employees, such as gym memberships, wearables or other preventive care initiatives.
States can offer premium cost savings or other incentives to those who choose to engage in health activities and have better health outcomes through the programs. Enrollees would have to meet certain health standards and states will have to offer a “reasonable alternative” for those who have a medical condition, such as a pre-existing condition, and cannot meet the wellness program standard. The program can have two approaches––a state-wide standardized wellness program or more flexibility in health insurer-designed programs.
“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,” CMS Administrator Seema Verma said in a statement.
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According to CMS, wellness programs––which have not been proven to lower healthcare costs or boost health outcomes––have not previously been available to those who get their health insurance coverage from the individual market. The Affordable Care Act does not allow individual market health-contingent wellness programs beyond the demonstration.
The programs must not reduce coverage or come at a cost to the federal government through financial subsidies in the exchanges. They also cannot discriminate based on health status.
States that are approved for such programs will be required to submit data on the number of participants, the rewards offered, overall issuer cost savings and changes in participant behavior and utilization or medical claims starting three years after approval and annually after that. With that data, HHS and Department of Labor will review and decide if they will expand the project to other states.
Date: october 03, 2019