The ACA and Beyond:What is the Future for EAPs?

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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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Recent Relevant Federal Legislation

Not since the Federal Executive Order 12564 of 1986 andthe Drug-Free Workplace Act of 1988 has activity at thefederal level had as much potential to impact the EAP field.Three current federal laws/regulations which haveimplications for current and future EAP practice anddelivery are:

• 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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The Affordable Care Act (ACA) The ACA is the widest-ranging reform of US healthcare in 50years, and its details continue to be finalized.

• Its goals include: greater access to health insurance,establishing basic levels of coverage, improving the qualityand efficiency of care, prevention of chronic disease, andimproved public health.

• Its includes provisions intended to encourage workplacehealth promotion to reduce the burden of chronic illness,improve health, and slow the growth of health care costs.

• In addition to patient care reforms, the ACA containsmarket reforms which apply to group health plans or healthinsurance issuers providing coverage, and MAY includecertain types of EAPs.

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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 Plan5

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 plans6

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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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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The Health Information Technology for Economic & Clinical Health Act (HITECH)This legislation promotes the adoption, meaningful use andregulation of health information technology.

• Subtitle D addresses the privacy and security concernsassociated with electronic transmission of confidentialhealth information.

• The law requires HIPAA covered entities, in addition tonotifying the affected individuals, to report data breachesaffecting 500+ individuals to HHS and the media, and setsnew criminal, civil and financial penalties for confidentialdata breaches.

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HITECH Act - Implications for EAPs

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The Mental Health Parity & Addiction Equity Act (MHPAEA)

Fundamentally changes access to available services for mentalhealth and substance use disorders. Requires parity in treatmentservices for MH/SUDs, prescription drugs, rehabilitative,prevention and wellness services.

Limits on frequency of treatment, number of visits, days ofcoverage, or scope and duration of treatment for MH/SUDs cannotbe any restrictive than for medical and surgical benefits.

Annual and lifetime limits, copayments, coinsurance requirements,deductibles, and out-of-pocket expenses for MH/SUDs may not bemore restrictive than for medical and surgical services.

Coverage for MH/SUD services provided by out-of-networkproviders must be consistent with the coverage of out-of-networkmedical and surgical services.

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MHPAEA - Implications for EAPs

Research indicates that while parity increases numbersof individuals using MH/SUD services, resulting costincreases for health plans is > 1%*.

• Eliminates higher co-pay and deductible amounts ofMH/SUD services, as well as separate deductibles forMH/SUD services;

• Eliminates the use of care management tools to denyservices;

• Eliminates the EAP role as a gatekeeper to services

• Will likely increase availability of MH/SUD services

* Sources: SAMHSA & CBO 12

EAPs & Workplace Wellness

• As defined by the ACA wellness benefits can beoffered by employers: 1) directly to all employees, or2) through group health plans to plan members.

• Wellness programs may include a combination ofhealth risk screenings with population-basedstrategies and individually-focused interventions toreduce those risks.

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Some Emerging Areas are Unclear

The status of some EAPs as “exemptedbenefits” under the ACA.

Will the ACA’s health insurance marketplacesbegin a longer trend of removing employersas the primary source of healthcare insurers?

Will market forces continue to maintaindownward pressure on pricing for EAservices?

Will EAPs become the ‘go to’ source fordelivering workplace wellness programs?

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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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What are your ideas for the future of EAPs?

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One thing is certain, the future of EAPs depends on good research

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