A 2-prong question with regard to workplace wellness programs. Acknowledging that these programs come in many flavors, let's start with the assumption that we are talking about a program that is providing biometric data assessments (cholesterol & glucose screening, height/weight/BMI, etc) to participants, and subsequently reports that data in a cumulative, de-identified manner back to the plan sponsor. Two questions:
#1 - Is the Wellness Program provider a BA, or not? (I realize there are implications regarding ERISA, MEWA's etc at play, but taking the question on its face...)
#2 - Inasmuch as data that may impact a participant's cost sharing is being transmitted by the Wellness program to the plan sponsor - under 45 CFR 162, does this constitute an electronic transaction that would imply that that the wellness program is actually performing a covered transaction, making the wellness program a provider under this part?
In the past, this type of information could be utilized to determine rate setting because there would be more relevant data to determine claim risk. Should there be a concern that even if Medicare rates could not be impacted, a vendor who furnishes products for the commercial or non-Medicare community may transfer risk to an unrelated population. Perhaps I am missing the intent of the collection and sharing of this type of information outside of support on the individual participant and determining future programs. .
Director - Public Sector Plans & Corporate Compliance
First Continental Life & Accident Ins Co./StarDent
101 Parklane Blvd. Suite 301
Sugar Land, TX 77478
Contact: 281.276.1033 Mobile: 832.277.5927 Fax: 832.532.4068