The CMS has launched a pilot project for states to implement health-contingent wellness programs in the individual market.
The states will be able to offer residents lower premiums or other incentives if they choose to participate in the state's wellness program through the individual market. The CMS is currently seeking applications for the project, which will involve 10 states.
"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.
The project is part of a mandate under the Affordable Care Act that added a provision to the Public Health Service Act calling for health-contingent wellness programs to be tested in the individual market through a pilot project operated by HHS, the Department of Labor and the Treasury Department.
Health-contingent wellness programs aren't currently allowed in the individual market. They involve participants receiving a reward if they achieve or reach a certain health outcome. These programs are different from participatory wellness programs which awards individuals for participating in the program without assessing if it led to changes in certain health outcomes. Participatory wellness programs have been allowed in the individual market since 2013.
The CMS will only approve applications from states if they can demonstrate that the wellness program won't result in coverage losses or rises in cost for the federal government through subsidies. Finally, the programs can't discriminate based on a person's health status. States would have to offer an alternative to those who can't participate due to a medical condition.
Although wellness programs are popular, a recent study found they don't lead to meaningful improvements in health outcomes. The study, which was a large randomized clinical trial, found participants didn't have lower body mass index, blood pressure or cholesterol compared to those who weren't in the programs. Reductions in healthcare spending was also minimal, according to the study.
