123-6-03 Wellness program best practice.

All health care plans shall include a wellness or healthy lifestyle program.

(A) The required components of an acceptable wellness or healthy lifestyle program under this rule specifically include but are not limited to:

(1) Conducting an initial evaluation of historical claims experience if available to specifically identify health conditions that are modifiable and preventable through health improvement, health management, and patient compliance.

(2) A personal health assessment tool capable of providing an accurate and comprehensive baseline of population health status. The personal health assessment must:

(a) Be available in multiple formats including both online and paper media;

(b) Be reasonable in length;

(c) Capture modifiable and non-modifiable risk factors;

(d) Assess an individual's confidence and readiness to change his or her lifestyle, potential barriers to change, and include quality of life measures;

(e) Capture current contact information and preferred means of contact;

(f) Generate a personalized report for the individual that addresses lifestyle changes they can make to improve their health and reduce risks.

(3) Conduct a biometric screening at the health plan sponsor location(s) of choice.

This screening must include:

(a) Cholesterol levels;

(b) Diabetic risk assessment;

(c) Blood pressure;

(d) Body mass index (BMI), including recording of height and weight and body composition.

(4) Provide proactive, ongoing support and education for individuals with lifestyle health risks, such as tobacco use, obesity, high blood pressure, high cholesterol, and high stress. This support and education must:

(a) Include access to personalized health coaching;

(b) Be available in multiple formats, including telephone, email and the internet;

(c) Be provided by qualified professionals.

(5) Include processes or programs that encourage the highest levels of participation possible at the onset of the program, make it attractive to enroll in the program at any time and to keep participants engaged throughout the duration of the program.

(6) Provide regularly scheduled reports to the health plan sponsor demonstrating the impact of the program in aggregate, including:

(a) Personal health assessment completion rates;

(b) Outcome-oriented metrics such as reductions in BMI, smoking cessation rates and other quantifiable improvements in behavior.

(B) The use and disclosure of health information collected through health risk assessments shall respect patient confidentiality and may not be used or disclosed for any purpose other than allowed by state or federal law to improve the health status of participating members.

Replaces: 3306-2-03

Effective: 02/24/2011
R.C. 119.032 review dates: 12/31/2015
Promulgated Under: 119.03
Statutory Authority: 9.901
Rule Amplifies: 9.901
Prior Effective Dates: 1/1/2009