S.Amdt. 3285

SA 3285. Mr. GREGG submitted an amendment intended to be proposed to
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr.
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal
Revenue Code of 1986 to modify the first-time homebuyers credit in the
case of members of the Armed Forces and certain other Federal
employees, and for other purposes; which was ordered to lie on the
table; as follows:

On page 80, line 22, strike ``and''.
On page 80, after line 25, add the following:
``(i) adherence to or participation in reasonably designed
programs of health promotion and disease prevention, if such
programs exist; and''.
On page 81, line 4, insert before the period the following:
``, except that group health plans and health insurance
issuers offering group or individual health insurance
coverage may establish premium discounts or rebates for
modifying otherwise applicable copayments or deductibles in
return for adherence to or participation in reasonably
designed programs of health promotion or disease
prevention''.
Beginning on page 84, strike line 15 and all that follows
through line 3 on page 94, and insert the following:
``(j) Programs of Health Promotion or Disease Prevention.--
``(1) General provisions.--
``(A) General rule.--For purposes of subsection (b)(2)(B),
a program of health promotion or disease prevention (referred
to in this subsection as a `wellness program') shall be a
program that is designed to promote health or prevent disease
that meets the applicable requirements of this subsection.
``(B) No conditions based on health status factor.--If none
of the conditions for obtaining a premium discount or rebate
or other reward for participation in a wellness program is
based on an individual satisfying a standard that is related
to a health status factor, such wellness program shall not
violate this section if participation in the program is made
available to all similarly situated individuals and the
requirements of paragraph (2) are complied with.
``(C) Conditions based on health status factor.--If any of
the conditions for obtaining a premium discount or rebate or
other reward for participation in a wellness program is based
on an individual satisfying a standard that is related to a
health status factor, such wellness program shall not violate
this section if the requirements of paragraph (3) are
complied with.
``(2) Wellness programs not subject to requirements.--If
none of the conditions for obtaining a premium discount or
rebate or other reward under a wellness program as described
in paragraph (1)(B) are based on an individual satisfying a
standard that is related to a health status factor (or if
such a wellness program does not provide such a reward), the
wellness program shall not violate this section if
participation in the program is made available to all
similarly situated individuals. The following programs shall
not have to comply with the requirements of paragraph (3) if
participation in the program is made available to all
similarly situated individuals:
``(A) A program that reimburses all or part of the cost for
memberships in a fitness center.
``(B) A diagnostic testing program that provides a reward
for participation and does not base any part of the reward on
outcomes.
``(C) A program that encourages preventive care related to
a health condition through the waiver of the copayment or
deductible requirement under an individual or group health
plan for the costs of certain items or services related to a
health condition (such as prenatal care or well-baby visits).
``(D) A program that reimburses individuals for the costs
of smoking cessation programs without regard to whether the
individual quits smoking.
``(E) A program that provides a reward to individuals for
attending a periodic health education seminar.
``(3) Wellness programs subject to requirements.--If any of
the conditions for obtaining a premium discount, rebate, or
reward under a wellness program as described

[[Page S13632]]

in paragraph (1)(C) is based on an individual satisfying a
standard that is related to a health status factor, the
wellness program shall not violate this section if the
following requirements are complied with:
``(A) The reward for the wellness program, together with
the reward for other wellness programs with respect to the
plan that requires satisfaction of a standard related to a
health status factor, shall not exceed 30 percent of the cost
of employee-only coverage under the plan. If, in addition to
employees or individuals, any class of dependents (such as
spouses or spouses and dependent children) may participate
fully in the wellness program, such reward shall not exceed
30 percent of the cost of the coverage in which an employee
or individual and any dependents are enrolled. For purposes
of this paragraph, the cost of coverage shall be determined
based on the total amount of employer and employee
contributions for the benefit package under which the
employee is (or the employee and any dependents are)
receiving coverage. A reward may be in the form of a discount
or rebate of a premium or contribution, a waiver of all or
part of a cost-sharing mechanism (such as deductibles,
copayments, or coinsurance), the absence of a surcharge, or
the value of a benefit that would otherwise not be provided
under the plan. The Secretaries of Labor, Health and Human
Services, and the Treasury may increase the reward available
under this subparagraph to up to 50 percent of the cost of
coverage if the Secretaries determine that such an increase
is appropriate.
``(B) The wellness program shall be reasonably designed to
promote health or prevent disease. A program complies with
the preceding sentence if the program has a reasonable chance
of improving the health of, or preventing disease in,
participating individuals and it is not overly burdensome, is
not a subterfuge for discriminating based on a health status
factor, and is not highly suspect in the method chosen to
promote health or prevent disease. The plan or issuer shall
evaluate the program's reasonableness at least once per year.
``(C) The plan shall give individuals eligible for the
program the opportunity to qualify for the reward under the
program at least once each year.
``(D) The full reward under the wellness program shall be
made available to all similarly situated individuals. For
such purpose, among other things:
``(i) The reward is not available to all similarly situated
individuals for a period unless the wellness program allows--

``(I) for a reasonable alternative standard (or waiver of
the otherwise applicable standard) for obtaining the reward
for any individual for whom, for that period, it is
unreasonably difficult due to a medical condition to satisfy
the otherwise applicable standard; and
``(II) for a reasonable alternative standard (or waiver of
the otherwise applicable standard) for obtaining the reward
for any individual for whom, for that period, it is medically
inadvisable to attempt to satisfy the otherwise applicable
standard.

``(ii) If reasonable under the circumstances, the plan or
issuer may seek verification, such as a statement from an
individual's physician, that a health status factor makes it
unreasonably difficult or medically inadvisable for the
individual to satisfy or attempt to satisfy the otherwise
applicable standard.
``(E) The plan or issuer involved shall disclose in all
plan materials describing the terms of the wellness program
the availability of a reasonable alternative standard (or the
possibility of waiver of the otherwise applicable standard)
required under subparagraph (D). If plan materials disclose
that such a program is available, without describing its
terms, the disclosure under this subparagraph shall not be
required.
``(k) Existing Programs.--Nothing in this section shall
prohibit a program of health promotion or disease prevention
that was established prior to the date of enactment of this
section and applied with all applicable regulations, and that
is operating on such date, from continuing to be carried out
for as long as such regulations remain in effect.
``(l) Regulations.--Nothing in this section shall be
construed as prohibiting the Secretaries of Labor, Health and
Human Services, or the Treasury from promulgating regulations
in connection with this section.''.
______