211 CMR, § 151.15

Current through Register 1533, October 25, 2024
Section 151.15 - Standards for Certified Group Purchasing Cooperative Wellness Programs
(1) The Wellness Program shall be administered by the certified Group Purchasing Cooperative or by an entity that has contracted with the certified Group Purchasing Cooperative. The certified Group Purchasing Cooperative shall be responsible for all the features of the Wellness Program(s) , which shall be conducted pursuant to a written plan, under the supervision of a properly trained health practitioner and staffed by appropriately trained and qualified personnel, and shall include a documented process to:
(a) Conduct health risk assessments, at least annually, of all Insureds participating in the Wellness Program(s), according to a tool that has been accredited by the National Committee on Quality Assurance;
(b) Develop reasonable health maintenance or improvement goals with each Wellness Program participant based upon factors derived from the participant's health risk assessment;
(c) Record each participant's activities designed to address wellness goals and, as appropriate, provide workplace or other geographically convenient wellness monitoring locations;
(d) Monitor participants' progress toward meeting wellness goals and assign trained and qualified lifestyle coaches to assist participants to keep on track with goals and develop ways to encourage continued activities to achieve desired goals including through financial or other incentives, periodic reminders and/or motivational interviewing;
(e) Measure, at least annually, the Wellness Program's effectiveness at developing goals that improve participants' health status, promoting adherence to planned goals and changing overall trends in health status, and redesigning the program to address new or persistent health issues;
(f) Maintain the confidentiality of each participant's health risk assessment and progress toward reaching the participant's individualized health goals; and
(g) Maintain Wellness Programs consistent with state and federal statutes, regulations and guidelines, including required accommodations made for those with physical or other disabilities that could prevent participation in standard programs.
(2) The Wellness Program shall, at minimum, be designed to address the prevention and management of heart disease, stroke, diabetes, asthma, cancer and the following risk factors:
(a) High blood pressure;
(b) Smoking;
(c) Substance abuse and prescription non-compliance;
(d) Adult and child obesity;
(e) Depression;
(f) Stress and work-life balance;
(g) Inactivity;
(h) Unhealthy diets (high sugar, high sodium, high saturated fat and low fiber);
(i) Elevated cholesterol;
(j) Elevated blood glucose; and
(k) Workplace policies/environments that may impact individual health.
(3) The criteria for the Wellness Program shall be, to the maximum extent feasible, scientifically derived and evidence-based, and developed with the input of appropriate medical professionals.
(4) A certified Group Purchasing Cooperative shall coordinate with a Carrier's Wellness Program data processing systems to enable the certified Group Purchasing Cooperative to effectively provide guidance to Eligible Association Members, Eligible Small Businesses, Eligible Employees and Eligible Dependents regarding targeted Wellness Programs.

211 CMR, § 151.15