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HHS Issues 2014 Rules for Health Plans, Exchanges

Cheryl Clark, for HealthLeaders Media, November 21, 2012

3. Wellness incentives
For group health coverage, the proposed rule, which was developed in collaboration with the Department of Labor, would raise the allowable amount of the incentives, and permit incentives of two types for employer-based plans. The first comes without regard to an individual's health status, such as reimbursement for membership in a qualified gym, credit for attending a health education seminar, or a reward for employees who complete a health assessment.

The second type would require individuals to meet certain goals before they could receive the reward. For example, people with high cholesterol or weight issues would receive a credit if they achieved reduction targets.

According to a press statement, the programs "must have a reasonable chance of improving health or preventing disease and not be overly burdensome for individuals." Alternatives to receive rewards would be made available for those "whose medical conditions make it unreasonably difficult, or for whom it is medically inadvisable, to meet the specified health-related standard."

Asked to respond to recent statements from governors of some states that are resisting the exchanges, such as Texas, Cohen emphasized that the federal government will step in if the state fails to act, because that's what the law mandates. It is to the state's benefit to run its own program, however, because the state will then have autonomy to decide how the costs of running the exchange would be distributed.

"If the state is running the exchange, the state gets to decide how those costs will be assessed," Cohen said. "Should it be assessed only on companies that are selling products through the exchange, or assessed on the entire insurance market...that's totally up to the state...as opposed to having CMS [the Centers for Medicare & Medicaid Services] do it."

HHS requests that comments be posted on Regulations.gov within 30 days after these rules are published in the Federal Register over the next several days.


Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
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1 comments on "HHS Issues 2014 Rules for Health Plans, Exchanges"


Elizabeth Beil (11/29/2012 at 4:17 PM)
If we won't have the exchanges up and running until 10/01/2013 I assume that we will not know the companies/plans that are participating. I do the credentialing for our practice and wonder how will these as yet to be determined companies are going to be able to credential the providers to service these plans. As it is it takes the insurance companies many months to complete credentialling or even recredentialing our practitioners.