title: Participatory workplace wellness programs: reward, penalty, and regulatory conflict.
abstract: POLICY POINTS: Workplace wellness programs that provide incentives for completing a health risk assessment are a form of participatory programs. There are legal and ethical concerns when employers assess penalties for not completing a health risk assessment, raising questions about the voluntariness of such a program. The Departments of Treasury, Labor, and Health and Human Services' 2013 regulations for participatory programs and employers' current practices conflict with the Equal Employment Opportunity Commission's prevailing interpretation of the Americans with Disabilities Act of 1990.
  
  
  BACKGROUND
  In keeping with the Patient Protection and Affordable Care Act, Congress revised the law related to workplace wellness programs. In June 2013, the Departments of Treasury, Labor, and Health and Human Services passed the final regulations, updating their 2006 regulatory framework. Participatory programs that reward the completion of a health risk assessment are now the most common type of wellness program in the United States. However, legal and ethical concerns emerge when employers utilize incentives that raise questions about the voluntariness of such programs. At issue is that under the Americans with Disabilities Act (ADA) of 1990, employers cannot require health-related inquiries and exams.
  
  
  METHODS
  To analyze the current interpretation of the ADA, I conducted research on both LexisNexis and federal agency websites. The resulting article evaluates the differences in the language of Congress's enabling legislation and the federal departments' regulations and how they may conflict with the ADA. It also reviews the federal government's authority to address both the legal conflict and ethical concerns related to nonvoluntary participatory programs.
  
  
  RESULTS
  Employers' practices and the federal departments' regulations conflict with the current interpretation of the ADA by permitting employers to penalize employees who do not complete a health risk assessment. The departments' regulations may be interpreted as conflicting with Congress's legislation, which mentions penalties only for health-contingent wellness programs. Furthermore, the regulatory protections for employees applicable to health-contingent wellness programs do not apply to participatory programs.
  
  
  CONCLUSIONS
  Either Congress or the federal agencies should address the conflict among employers' practices, the wellness regulations, and the ADA and also consider additional protections for employees. Employers can avoid ethical and legal complications by offering voluntary programs with positive incentives.
authors.affiliation: College of Public Health, Temple University.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Pomeranz
mesh_terms: D002961:Civil Rights / Q000331:legislation & jurisprudence; D003256:Community Participation; D003219:Confidentiality / Q000331:legislation & jurisprudence; D006233:Persons with Disabilities / Q000331:legislation & jurisprudence*; D006293:Health Promotion / Q000941:ethics / Q000331:legislation & jurisprudence* / Q000458:organization & administration; D006801:Humans; D009042:Motivation; D016272:Occupational Health / Q000941:ethics / Q000331:legislation & jurisprudence*; D058991:Patient Protection and Affordable Care Act; D018570:Risk Assessment / Q000331:legislation & jurisprudence / Q000379:methods; D014481:United States; D017132:Workplace
keywords: ethics; health information; health law; workplace wellness programs