This presentation, The ACA and Beyond: What is the Future for EAPs? was a plenary session provided to the 2014 MA/RI EAPA Annual Symposium in Waltham, MA on May 10, 2014.

1. The ACA and Beyond: What is the Future for EAPs?
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2. We Live in Interesting Times
In 2014, EAPs continue to change and evolve
•Trends influencing this include:
Social Forces –changing mores/work patterns
Healthcare Reform –primarily in the US
Web & Mobile-based Technology –expanded social media and other electronic interactions
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3. Recent Relevant Federal Legislation
NotsincetheFederalExecutiveOrder12564of1986andtheDrug-FreeWorkplaceActof1988hasactivityatthefederallevelhadasmuchpotentialtoimpacttheEAPfield. Threecurrentfederallaws/regulationswhichhaveimplicationsforcurrentandfutureEAPpracticeanddeliveryare:
•The Patient Protection & Affordable Care Act
•The Health Information Technology for Economic and Clinical Health Act
•The Mental Health Parity & Addiction Equity Act
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4. The Affordable Care Act (ACA)
TheACAisthewidest-rangingreformofUShealthcarein50years,anditsdetailscontinuetobefinalized.
•Itsgoalsinclude:greateraccesstohealthinsurance, establishingbasiclevelsofcoverage,improvingthequalityandefficiencyofcare,preventionofchronicdisease,andimprovedpublichealth.
•Itsincludesprovisionsintendedtoencourageworkplacehealthpromotiontoreducetheburdenofchronicillness, improvehealth,andslowthegrowthofhealthcarecosts.
•Inadditiontopatientcarereforms,theACAcontainsmarketreformswhichapplytogrouphealthplansorhealthinsuranceissuersprovidingcoverage,andMAYincludecertaintypesofEAPs.
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5. A Functional Definition of EAPs?
One far-reaching impact of the
ACA may be its potential to create two distinct, functional types of EAPs
Non-exempted benefit EAPs which provide a significant benefit in the nature of medical care
Exempted benefit EAPs which do not provide a significant benefit in the nature of medical care
ACA = Health Plan
ACA = non Health Plan
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6. ACA -Implications for EAPs (+)
+Health Insurance Market Reform:
•Eliminates medical underwriting
•Eliminates lifetime and annual limits on treatment*
•Extends dependent coverage
•Requires uniform policy documents
•Requires an appeal process for denial of care
+Status of EAPs as exempted benefits
•If federal agencies rule liberally on EAPs as ‘exempted benefits’
+Status of wellness programs as exempted benefits
•If federal agencies rule liberally on wellness programs as exempted will provide opportunities for EAPs to expand into this area or collaborate with existing wellness programs.
*for certain health plans
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7. ACA -Implications for EAPs (≈)
≈Status of EAPs as exempted benefits
•If agencies rule EAPs can or cannot be financed by another group plan –this provision has varied implications for different sectors of the EAP market.
Some public sector EAPs support outside financing to preserve services
Some regional, entrepreneurial EAPs see outside financing as contributing to an erosion of quality and an increase in commoditization
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8. ACA -Implications for EAPs (-)
−Status of EAPs as exempted benefits
•Arbitrary limits to EAPs, e.g., a maximum number of 10 outpatient sessions may:
1) Limit SAP services provided by an EAP;
2) Encourage inappropriate use of web- based or telephonic or services vs. in- person sessions
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9. The Health Information Technology for Economic & Clinical Health Act (HITECH)
Thislegislationpromotestheadoption,meaningfuluseandregulationofhealthinformationtechnology.
•SubtitleDaddressestheprivacyandsecurityconcernsassociatedwithelectronictransmissionofconfidentialhealthinformation.
•ThelawrequiresHIPAAcoveredentities,inadditiontonotifyingtheaffectedindividuals,toreportdatabreachesaffecting500+individualstoHHSandthemedia,andsetsnewcriminal,civilandfinancialpenaltiesforconfidentialdatabreaches.
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10. HITECH Act -Implications for EAPs
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11. The Mental Health Parity & Addiction Equity Act (MHPAEA)
Fundamentallychangesaccesstoavailableservicesformentalhealthandsubstanceusedisorders.RequiresparityintreatmentservicesforMH/SUDs,prescriptiondrugs,rehabilitative, preventionandwellnessservices.
Limitsonfrequencyoftreatment,numberofvisits,daysofcoverage,orscopeanddurationoftreatmentforMH/SUDscannotbeanyrestrictivethanformedicalandsurgicalbenefits.
Annualandlifetimelimits,copayments,coinsurancerequirements, deductibles,andout-of-pocketexpensesforMH/SUDsmaynotbemorerestrictivethanformedicalandsurgicalservices.
CoverageforMH/SUDservicesprovidedbyout-of-networkprovidersmustbeconsistentwiththecoverageofout-of-networkmedicalandsurgicalservices.
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12. MHPAEA -Implications for EAPs
ResearchindicatesthatwhileparityincreasesnumbersofindividualsusingMH/SUDservices,resultingcostincreasesforhealthplansis>1%*.
•Eliminateshigherco-payanddeductibleamountsofMH/SUDservices,aswellasseparatedeductiblesforMH/SUDservices;
•Eliminatestheuseofcaremanagementtoolstodenyservices;
•EliminatestheEAProleasagatekeepertoservices
•WilllikelyincreaseavailabilityofMH/SUDservices
* Sources: SAMHSA & CBO
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13. EAPs & Workplace Wellness
•AsdefinedbytheACAwellnessbenefitscanbeofferedbyemployers:1)directlytoallemployees,or2)throughgrouphealthplanstoplanmembers.
•Wellnessprogramsmayincludeacombinationofhealthriskscreeningswithpopulation-basedstrategiesandindividually-focusedinterventionstoreducethoserisks.
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14. Some Emerging Areas are Unclear
ThestatusofsomeEAPsas“exemptedbenefits”undertheACA.
WilltheACA’shealthinsurancemarketplacesbeginalongertrendofremovingemployersastheprimarysourceofhealthcareinsurers?
WillmarketforcescontinuetomaintaindownwardpressureonpricingforEAservices?
WillEAPsbecomethe‘goto’sourcefordeliveringworkplacewellnessprograms?
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15. Evolving EAPs of the future will likely…
1.Choose to remain independent from or integrate with healthcare organizations, based on their status.
2.Adopt a greater reliance on web-based delivery platforms.
3.Provide more extensive wellness activities to engage employees and increase employer loyalty.
4.Embrace outcome studies as a methodology to demonstrate their contribution to worker health and productivity.
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16. What are your ideas for the future of EAPs?
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17. One thing is certain, the future of EAPs depends on good research
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