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  • Public Affairs

  • Provisions in the Patient Protection and Affordable Care Act 2010

    (Became law on March 23, 2010)

    Wellness Incentives (Sec. 1201) – Codifies an amended version of the HIPAA wellness program regulations. Wellness programs that do not require an individual to satisfy a standard related to a health factor as a condition for obtaining a reward (or do not offer a reward) would not violate HIPAA, so long as participation in the programs is made available to all similarly situated individuals. Wellness programs with conditions for obtaining a reward that are based on an individual meeting a certain standard relating to a health factor, would have to meet additional requirements. Among these requirements, the reward must be capped at 30% of the cost of the employee-only coverage under the plan (instead of 20% under the current regulations), but the Secretaries of HHS, Labor, and the Treasury would have the discretion to increase the reward up to 50%.

    The HHS Secretary, in consultation with the Secretaries of the Treasury and Labor, would establish a 10-state pilot program in which participating states would be required to apply the wellness program provisions to health insurers in the individual market.

    Wellness and Health Promotion (Sec. 1201) – Requires the Secretary to develop reporting requirements for group health plans and health insurance issuers with respect to plan or coverage benefits and health care provider reimbursement structures that, among other things, implement “wellness and health promotion activities.”

    Under this section, wellness and health promotion activities could include personalized wellness and prevention services “that are coordinated, maintained or delivered by a health care provider, a wellness and prevention plan manager, or a health, wellness or prevention services organization that conducts health risk assessments or offers ongoing face-to-face, telephonic or web-based intervention efforts for each of the program’s participants....”

    Coverage of Preventive Health Services (Sec. 2713) – Stipulates that a group health plan and a health insurance issuer offering group or individual health insurance coverage shall provide coverage for and shall not impose any cost sharing requirements for:

    • evidence based items or services that have in effect a rating of ‘A’ or ‘B’ in the current recommendations of the US Preventive Services Task Force (USPSTF);
    • immunizations that have in effect a recommendation from the Advisory Committee on Immunization Practices of the CDC with respect to the individual involved;

    National Prevention, Health Promotion & Public Health Council (Sec. 4001) – Creates a council within HHS to provide coordination and leadership at the federal level, and among federal departments and agencies, with respect to prevention, wellness and health promotion practices, the public health system and integrative health care in the U.S. and to develop the National Prevention Strategy. The Council shall be composed of departmental secretaries from across the federal government, with the Surgeon General serving as Chair.

    Advisory Group on Prevention, Health Promotion, and Integrative and Public Health (Sec. 4001) – The President is to appoint an Advisory Group to the National Prevention, Health Promotion and Public Health Council. The Advisory Group is to include a diverse group of licensed health professionals, including integrative health practitioners who have expertise in specific areas including worksite health promotion and preventive medicine.

    National Prevention and Health Promotion Strategy (Sec. 4001) – Tasks the Council with creating a national strategy to: set goals and objectives for improving health through federally supported prevention, health promotion and public health programs, establish measurable actions and timelines to carry out the strategy, and make recommendations to improve federal prevention, health promotion, public health and integrative health care practices.

    Prevention and Public Health Fund (Sec. 4002) – Establishes a fund, to be administered through the Office of the Secretary at HHS, to provide for an expanded and sustained national investment in prevention and public health programs. The Fund will support programs authorized by the Public Health Service Act, for prevention, wellness and public health activities, including prevention research and health screenings and initiatives.

    Employer-Based Wellness Programs (Sec. 4303) – Directs CDC to provide employers with technical assistance, consultation and tools in evaluating wellness programs and build evaluation capacity among workplace staff. Directs CDC to study and evaluate employer-based wellness practices. Clarifies that any recommendations, data, or assessments carried out under this part shall not be used to mandate requirements for workplace wellness programs.

    Grants for Small Businesses to Provide Comprehensive Workplace Wellness Programs
    (Sec. 10408)
    – Directs the Secretary to award grants to small businesses to provide employees with
    access to comprehensive workplace wellness programs.

    Effectiveness of Federal Health and Wellness Initiatives (Sec. 4402) – Requires the Secretary of HHS to evaluate all existing federal health and wellness initiatives and report to Congress concerning the evaluation, including conclusions concerning the reasons that such existing programs have proven successful or not successful and what factors contributed to such conclusions.

    Preventive Medicine and Public Health Training Grant Program -- Directs the Secretary to award grants to or enter into contracts with eligible entities to provide training to graduate medical residents in preventive medicine specialties.


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