Massachusetts Wellness Tax Credit
Incentive
Request to Promulgate Final Amendments to 105 CMR 216.000
Cheryl Bartlett, RN
Director, Bureau of Community Health and Prevention
Interim Deputy Commissioner
Public Health Council Meeting
April 10, 2013
Agenda
•Background
•Summary of Public Comments
•Next Steps and Request for Action
2
Background
• August 4, 2012: Governor Deval Patrick approved
Chapter 224: An Act Improving the Quality of Health
Care and Reducing Costs Through Increased
Transparency, Efficiency and Innovation.
• January 1, 2013: The effective date of sections of
Chapter 224 that establish a Massachusetts wellness
program tax credit.
• January 10, 2013: The Public Health Council approved
an emergency regulation.
• February 2013: Opportunity for public comment on the
emergency regulation
– Hearings: February 11 and 14
– Public Comment period ended
February 15
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Agenda
•Background
•Summary of Public Comments
•Next Steps and Request for Action
4
Commentors
• Business - Retailers Association of
Massachusetts; International Health,
Racket and Sportsclub Association.
• Providers – Health Promotional
Specialists; Workplace Wellness Council
of Massachusetts.
• Insurers – Fallon Community Health Plan.
• Advocacy groups – Health Care for All;
Massachusetts Coalition for Occupational
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Scope and Definition of Business Entity
Comment(s)
•Retailers Association of Massachusetts (RAM) requested that DPH
limit scope and eligibility to small businesses in the Commonwealth’s
small group insurance marketplace, as defined by regulations of the
Division of Insurance (DOI).
•DOI limits its definition of eligible small business to 50 or fewer
employees.
•The Affordable Care Act requires state small group markets to
expand to businesses with 100 or fewer employees.
6
Scope and Definition of Business Entity
Regulation Response
•Revised the scope of this regulation, Section 216.003, and the
associated definition of “business entity,” found in Section 216.004,
to apply to business entities with 200 or fewer employees (not 500
or fewer employees).
•The threshold of businesses with 200 or fewer employees:
– Meets the spirit of the law to incentivize
“smaller businesses”
– Is consistent with research conducted by
the Kaiser Family Foundation: Large firms
(200 or more workers) are more likely than
smaller firms (3-199 workers) to offer some
type of wellness program.
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Eligibility and Documentation
Comment(s)
•Massachusetts Coalition for Occupational Safety and Health and the
Center for the Promotion of Health in the New England Workplace at
UMASS Lowell raised concerns about unintended consequences.
•The Commonwealth may inadvertently, absent explicit regulation,
provide financial incentives to businesses that fail to pay into workers
compensation or are non-compliant with legal obligations of
employers, including wage and hour laws and occupational safety and
health laws.
8
Scope and Definition of Business Entity
Regulation Response
•Strengthened eligibility criteria, Section 216.005(A), to
require that the business is in compliance with all legal
obligations of employers.
•Added new Section 216.007(B)(7) requiring all
applicants to sign an Affirmation that the business entity:
– Complies with all legal obligations of
employers, including M.G.L. c.149 &
all applicable labor, licensing and tax
laws;
– Has purchased workers’
compensation insurance as required
by law;
9
Voluntary Participation
Comment(s)
•Providers and advocates recommended that the regulation address
the voluntary nature of employee participation.
•Advocates recommended an express prohibition that businesses not
be allowed to offer rewards or penalties.
10
Voluntary Participation
Regulation Response
•Revised eligibility criteria to add two new requirements
that the business entity:
– Inform all employees that participation
in the health risk assessment and in
the wellness program is voluntary.
See, Section 216.005(G).
– Ensure confidentiality of all employee
information gathered through the
wellness program and inform
employees of this confidentiality
policy. See, Section 216.005(H).
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Definitions
Comment(s)
•Providers and advocates requested flexibility to assess workforce
needs through anonymous surveys, and other means, to provide the
employer with de-identified aggregate information.
•Providers and advocates recommended revising definition of
“wellness” to encourage overall well-being and focus on keeping
health employees healthy, as opposed to concentrating on those with
health conditions or risks.
•One provider recommended that the definition of “wellness”
specifically mention “physical activity incentives” such as health club
memberships; however, advocates and researchers disagreed and
questioned the benefit for low wage, minority/immigrant populations.
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Voluntary Participation
Regulation Response
•Added a new definition:
– Health Risk Assessment: means a
systemic process for collection of
information from individuals regarding
health status and well-being so as to
identify their health risk factors or
chances of getting a disease or health
condition. The aggregate results of
such process guide the design of
comprehensive workforce wellness
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Third Party Insurers & Vendors Offering Common Wellness Programs
Comment(s)
Fallon Community Health Plan
•Raised concerns that smaller business may not have the resources
to develop a wellness program.
•Recommended that regulations permit third parties to submit
applications to the Department for certification of a common wellness
program that the third party insurer or vendor may offer to different
business entities.
•Sought clarification about whether an employer could submit
information about a portion of group premium costs that is attributable
to implementation of a wellness program.
14
Third Party Insurers & Vendors Offering Common
Wellness Programs
Regulation Response
•Added new eligibility criteria to permit businesses to
work with third party vendors to implement wellness
programming, See Section 216.005(J).
•No change to Section 216.006(B).
– The Department only has statutory
jurisdiction to provide a certificate or
seal of approval to wellness programs
implemented by business entities, not
third party insurers;
– Under Section 216.006(B), the
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Agenda
•Background
•Summary of Public Comments
•Next Steps and Request for Action
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Next Steps
• Businesses must apply for certification
to DPH annually by 12/31.
• The Department anticipates that
businesses will be able to apply online
for Certification of their Wellness
Program in the late spring of 2013.
• The Department will issue FAQs and
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Action Requested
• The Department Respectfully Requests
Final Approval of Amendments to 105
CMR 216.000: Massachusetts
Wellness Tax Credit Incentive.
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Thank You
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