CMS launching demonstration for wellness programs in individual market

 Title: wellness health healthy food diet exercise fitness CREDIT: Getty/udra
The Centers for Medicare & Medicaid Services is piloting a new program that would allow states to test comprehensive wellness programs in the individual market. (Getty/udra)

The Trump administration will allow 10 states to participate in a demonstration that will offer new flexibility to provide wellness programs in their individual market

The Centers for Medicare & Medicaid Services (CMS) issued a bulletin (PDF) Monday that invites states to apply for the pilot, an effort that dates back to the Obama administration. States that participate in the demonstration will have two options for designing the wellness program: Either build a blanket model that applies to all individual market plans, or allow the plan sponsors to design wellness programs themselves.

The demonstration will allow states to implement a broader set of wellness options for individual market plan members than was previously available, CMS said. States will be allowed to offer incentives such as premium cost savings for members that improve their health outcomes.

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“Today’s announcement is another example of President Trump’s commitment to driving better health outcomes by offering states new flexibility to innovate and empower Americans to make the best healthcare decisions for themselves and their families,” CMS Administrator Seema Verma said in a statement. “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.”

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States will have to strike a balance between offering those incentives and being as inclusive as possible, according to the announcement. They must provide alternatives for people with preexisting conditions who may not otherwise be able to participate, CMS said.

Any state applying to participate must also show the wellness program would not lead to coverage losses or increase costs for the federal government, CMS said. 

While testing the wellness programs, states will be required to submit data back to CMS on participation, the number of rewards provided and any cost savings. In addition, states will be asked to monitor behavioral changes and data on utilization and claims cost beginning three years before approval and annually after.

The departments of Health and Human Services, Labor and the Treasury will analyze these data to determine whether the pilot should grow, CMS said.

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