The American College of Occupational and Environmental Medicine (ACOEM) has presented formal comments to the U.S. Department of Health and Human Services (DHHS) on the proposed rule, “Incentives for Nondiscriminatory Wellness Programs in Group Health Plans” promulgated by DHHS and the Departments of Labor and Treasury.

The proposed rule, announced in the November 22 Federal Register, offers amendments to regulations, consistent with the Affordable Care Act, regarding non-discriminatory wellness programs in group health coverage. Specifically, the proposed regulations would increase the maximum permissible reward under a health-contingent wellness program offered in connection with a group health plan (and any related health insurance coverage) from 20 to 30% percent of the cost of coverage. The proposed regulations would increase the maximum permissible reward to 50% for wellness programs designed to prevent or reduce tobacco use. The regulations also include other proposed clarifications regarding the reasonable design of health-contingent wellness programs and the alternatives they must offer in order to avoid prohibited discrimination.

A key building block

“As the medical society devoted to promoting the health of workers, we believe strongly in the efficacy of evidence-based wellness and prevention programs in the workplace, said Dr. Karl Auerbach, ACOEM President in a January 25 letter to DHHS Secretary Kathleen Sebelius. “The evidence clearly demonstrates that these programs can be effective for improving health and productivity if well designed and implemented.”

In its comments, ACOEM emphasized that workplace is critical to health system reform, noting that workplace wellness programs are a key building block in helping promote a true culture of health in the workplace. “Rather than simply treating disease, wellness programs seek to keep healthy people healthy and bring people at high risk back from the brink of illness by managing health risk factors and promoting proactive health maintenance strategies,” ACOEM wrote.

The College further pointed out that workplace wellness programs do not have to be based solely on outcomes to succeed. “In fact, they are more likely to be successful if they encourage greater employee participation and buy-in, providing appropriate incentives that lead to active engagement in the programs which have been proven to yield better outcomes.”

ACOEM also agreed that worksite wellness programs must be designed to avoid discrimination and stressed that they should be tailored to achieve improved health outcomes for individuals. “Our guidance to employers is to take into account the needs of their workforce in designing the elements of a program so they are not overly burdensome. The language in the regulations should specifically state this requirement.”

Smoking v. other factors

The College did express concern regarding the up to 50% of total premium cost allowable for tobacco cessation vs. 30% available for all other risk factors, noting that “this allocation may give the signal to employees that tobacco cessation is of greater importance than other factors such as body mass index (BMI, glucose, blood pressure and cholesterol).”

In addition, ACOEM commented that it was pleased so many of the concepts embodied in the statement, Guidance for a Reasonably Designed, Employer-Sponsored Wellness Program Using Outcomes-Based Incentive, are reflected in the proposed rule. This statement, a collaboration of the Health Enhancement Research Organization, the American Cancer Society and American Cancer Action Network, the American Diabetes Association and the American Heart Association, was developed for the purpose of informing employers either considering or embarked on providing “health-centric” wellness programs what should be considered in their plan statement.

ACOEM’s complete letter including specific recommendations for integrating worksite wellness into the organizational structure of the workplace is available at