CMS announces wellness program demonstration for individual market

States can apply to participate in an Affordable Care Act demonstration program to implement wellness programs in their individual health insurance market, the Centers for Medicare & Medicaid Services announced yesterday. The departments of Health and Human Services and Labor expect to approve 10 states to participate in the project.
 
“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,” CMS said. “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.”
 
Applicants must show that their wellness programs will not decrease coverage; increase federal costs to provide financial subsidies through the health insurance exchanges; or discriminate based on health status, CMS said. If approved for the project, they must begin submitting annual data on the number of participants, rewards provided, overall issuer cost savings and changes in participant behavior and use or medical claims costs, which HHS and DOL will use to determine whether to expand the project to additional states.