I 

111TH CONGRESS 

1ST SESSION H. R. 3468 

To amend the Internal Revenue Code of 1986, the Public Health Service 

Act, and the Employee Retirement Income Security Act of 1974 to 

promote the use of prevention and wellness programs. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 31, 2009 

Mr. CASTLE (for himself, Mr. GERLACH, and Mr. LOBIONDO) introduced the 

following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means and Education and Labor, for a period to be subsequently determined by the 

Speaker, in each case for consideration of such provisions as fall within 

the jurisdiction of the committee concerned 

A BILL 

To amend the Internal Revenue Code of 1986, the Public 

Health Service Act, and the Employee Retirement Income Security Act of 1974 to promote the use of prevention and wellness programs. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Promoting Health and 

5 Preventing Chronic Disease through Prevention and 


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1 Wellness Programs for Employees, Communities, and In2 dividuals Act of 2009’’. 

3 SEC. 2. FINDINGS. 

4 Congress finds the following: 

5 (1) Keeping people healthy and preventing dis6 ease must be an important part of improving our 

7 federal health system. 

8 (2) More than 133 million Americans, which ac9 counts for 45 percent of the U.S. population, have 

10 at least one chronic condition. 

11 (3) With the growth in obesity, especially 

12 among younger Americans, the diagnosis of child13 hood chronic diseases has almost quadrupled over 

14 the past four decades and is expected to continue to 

15 rise. 

16 (4) Chronic diseases are the leading causes of 

17 preventable death and disability in the United 

18 States, accounting for 7 out of every 10 deaths and 

19 killing more than 1,700,000 people in the United 

20 States every year. 

21 (5) Two-thirds of the increase in health care 

22 spending is due to increased prevalence of treated 

23 chronic disease. 

24 (6) Seventy-five percent of the nation’s aggre25 gate health care spending is on treating patients 


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1 with chronic disease, and the vast majority of these 

2 diseases are preventable. Unfortunately, less than 

3 one percent of total health care spending goes to4 ward prevention. 

5 (7) According to a recent study, treatment of 

6 the seven most common chronic diseases, coupled 

7 with productivity losses, cost the U.S. economy more 

8 than $1 trillion dollars annually. It has been esti9 mated that modest reductions in unhealthy behaviors 

10 could prevent or delay 40 million cases of chronic ill11 ness per year. 

12 (8) Chronic diseases are burdensome to Amer13 ican businesses. Not only does a sicker American 

14 workforce have higher health care costs, but it is 

15 also less productive. Chronic illnesses lead to absen16 teeism and decreased effectiveness while at work due 

17 to illness. 

18 (9) Prevention not only saves lives, it is highly 

19 cost-effective. One study concluded that an invest20 ment of $10 per person per year in proven commu21 nity-based programs to increase physical activity, 

22 improve nutrition, and prevent smoking and other 

23 tobacco use could save the country more than $16 

24 billion annually within five years. This is a return of 

25 $5.60 for every $1 spent. 


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1 SEC. 3. TAX CREDIT TO EMPLOYERS FOR COSTS OF IMPLE2 MENTING PREVENTION AND WELLNESS PRO3 GRAMS. 

4 (a) IN GENERAL.—Subpart D of part IV of sub5 chapter A of chapter 1 of the Internal Revenue Code of 

6 1986 (relating to business related credits) is amended by 

7 adding at the end the following: 

8 ‘‘SEC. 45R. PREVENTION AND WELLNESS PROGRAM CRED9 IT. 

10 ‘‘(a) ALLOWANCE OF CREDIT.— 

11 ‘‘(1) IN GENERAL.—For purposes of section 38, 

12 the prevention and wellness credit determined under 

13 this section for any taxable year during the credit 

14 period with respect to an employer is an amount 

15 equal to 50 percent of the costs paid or incurred by 

16 the employer in connection with a qualified preven17 tion and wellness during the taxable year. For pur18 poses of the preceding sentence, in the case of any 

19 qualified prevention and wellness offered as part of 

20 an employer-provided group health plan, including 

21 health insurance offered in connection with such 

22 plan, only costs attributable to the qualified preven23 tion and wellness and not to the group health plan 

24 or health insurance coverage may be taken into ac25 count.


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1 ‘‘(2) LIMITATION.—The amount of credit al2 lowed under paragraph (1) for any taxable year shall 

3 not exceed the sum of— 

4 ‘‘(A) the product of $200 and the number 

5 of employees of the employer not in excess of 

6 200 employees, plus 

7 ‘‘(B) the product of $100 and the number 

8 of employees of the employer in excess of 200 

9 employees. 

10 ‘‘(b) QUALIFIED PREVENTION AND WELLNESS.—For 

11 purposes of this section— 

12 ‘‘(1) QUALIFIED PREVENTION AND

13 WELLNESS.—The term ‘qualified prevention and 

14 wellness’ means a program which— 

15 ‘‘(A) consists of any 3 of the prevention 

16 and wellness components described in sub17 section (c), and 

18 ‘‘(B) which is certified by the Secretary of 

19 Health and Human Services, in coordination 

20 with the Director of the Center for Disease 

21 Control and Prevention, as a qualified preven22 tion and wellness under this section. 

23 ‘‘(2) PROGRAMS MUST BE CONSISTENT WITH

24 RESEARCH AND BEST PRACTICES.— 


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1 ‘‘(A) IN GENERAL.—The Secretary of 

2 Health and Human Services shall not certify a 

3 program as a qualified prevention and wellness 

4 unless the program— 

5 ‘‘(i) is consistent with evidence-based 

6 research and best practices, as identified 

7 by persons with expertise in employer 

8 health promotion and prevention and 

9 wellnesss, 

10 ‘‘(ii) includes multiple, evidence-based 

11 strategies which are based on the existing 

12 and emerging research and careful sci13 entific reviews, including the Guide to 

14 Community Preventive Services, the Guide 

15 to Clinical Preventive Services, and the 

16 National Registry for Effective Programs, 

17 and 

18 ‘‘(iii) includes strategies which focus 

19 on employee populations with a dispropor20 tionate burden of health problems. 

21 ‘‘(B) PERIODIC UPDATING AND REVIEW.— 

22 The Secretary of Health and Human Services 

23 shall establish procedures for periodic review of 

24 programs under this subsection. Such proce25 dures shall require revisions of programs if necVerDate Nov 24 2008 23:35 Aug 04, 2009 Jkt 079200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H3468.IH H3468

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1 essary to ensure compliance with the require2 ments of this section and require updating of 

3 the programs to the extent the Secretary, in co4 ordination with the Director of the Centers for 

5 Disease Control and Prevention, determines 

6 necessary to reflect new scientific findings. 

7 ‘‘(3) HEALTH LITERACY.—The Secretary of 

8 Health and Human Services shall, as part of the 

9 certification process, encourage employees to make 

10 the programs culturally competent and to meet the 

11 health literacy needs of the employees covered by the 

12 programs. 

13 ‘‘(c) PREVENTION AND WELLNESS PROGRAM COM14 PONENTS.—For purposes of this section, the prevention 

15 and wellness components described in this subsection are 

16 the following: 

17 ‘‘(1) HEALTH AWARENESS COMPONENT.—A 

18 health awareness component which provides for the 

19 following: 

20 ‘‘(A) HEALTH EDUCATION.—The dissemi21 nation of health information which addresses 

22 the specific needs and health risks of employees. 

23 ‘‘(B) HEALTH SCREENINGS.—The oppor24 tunity for periodic screenings for health probVerDate Nov 24 2008 23:35 Aug 04, 2009 Jkt 079200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H3468.IH H3468

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1 lems and referrals for appropriate follow up 

2 measures. 

3 ‘‘(2) EMPLOYEE ENGAGEMENT COMPONENT.— 

4 An employee engagement component which provides 

5 for— 

6 ‘‘(A) the establishment of a committee to 

7 actively engage employees in worksite preven8 tion and wellnesss through worksite assess9 ments and program planning, delivery, evalua10 tion, and improvement efforts, and 

11 ‘‘(B) the tracking of employee participa12 tion. 

13 ‘‘(3) BEHAVIORAL CHANGE COMPONENT.—A 

14 behavioral change component which provides for al15 tering employee lifestyles to encourage healthy living 

16 through counseling, seminars, on-line programs, or 

17 self-help materials which provide technical assistance 

18 and problem solving skills. Such component may in19 clude programs relating to— 

20 ‘‘(A) tobacco use, 

21 ‘‘(B) obesity, 

22 ‘‘(C) stress management, 

23 ‘‘(D) physical fitness, 

24 ‘‘(E) nutrition, 

25 ‘‘(F) substance abuse, 


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1 ‘‘(G) depression, and 

2 ‘‘(H) mental health promotion (including 

3 anxiety). 

4 ‘‘(4) SUPPORTIVE ENVIRONMENT COMPO5 NENT.—A supportive environment component which 

6 includes the following: 

7 ‘‘(A) ON-SITE POLICIES.—Policies and 

8 services at the worksite which promote a 

9 healthy lifestyle, including policies relating to— 

10 ‘‘(i) tobacco use at the worksite, 

11 ‘‘(ii) the nutrition of food available at 

12 the worksite through cafeterias and vend13 ing options, 

14 ‘‘(iii) minimizing stress and promoting 

15 positive mental health in the workplace, 

16 ‘‘(iv) where applicable, accessible and 

17 attractive stairs, and 

18 ‘‘(v) the encouragement of physical 

19 activity before, during, and after work 

20 hours. 

21 ‘‘(B) PARTICIPATION INCENTIVES.— 

22 ‘‘(i) IN GENERAL.—Qualified incentive 

23 benefits for each employee who participates 

24 in the health screenings described in paraVerDate Nov 24 2008 23:35 Aug 04, 2009 Jkt 079200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H3468.IH H3468

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1 graph (1)(B) or the behavioral change pro2 grams described in paragraph (3). 

3 ‘‘(ii) QUALIFIED INCENTIVE BEN4 EFIT.—For purposes of clause (i), the 

5 term ‘qualified incentive benefit’ means 

6 any benefit which is approved by the Sec7 retary of Health and Human Services, in 

8 coordination with the Director of the Cen9 ters for Disease Control and Prevention. 

10 ‘‘(C) EMPLOYEE INPUT.—The opportunity 

11 for employees to participate in the management 

12 of any qualified prevention and wellness to 

13 which this section applies. 

14 ‘‘(d) PARTICIPATION REQUIREMENT.— 

15 ‘‘(1) IN GENERAL.—No credit shall be allowed 

16 under subsection (a) unless the Secretary of Health 

17 and Human Services, in coordination with the Direc18 tor of the Centers for Disease Control and Preven19 tion, certifies, as a part of any certification described 

20 in subsection (b), that each prevention and wellness 

21 component of the qualified prevention and wellness 

22 applies to all qualified employees of the employer. 

23 The Secretary of Health and Human Services shall 

24 prescribe rules under which an employer shall not be 

25 treated as failing to meet the requirements of this 


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1 subsection merely because the employer provides 

2 specialized programs for employees with specific 

3 health needs or unusual employment requirements or 

4 provides a pilot program to test new wellness strate5 gies. 

6 ‘‘(2) QUALIFIED EMPLOYEE.—For purposes of 

7 paragraph (1), the term ‘qualified employee’ 

8 means— 

9 ‘‘(A) for employers offering health insur10 ance coverage, an employee who is eligible for 

11 such coverage, or 

12 ‘‘(B) for employers not offering health in13 surance coverage, an employee who works an 

14 average of not less than 25 hours per week dur15 ing the taxable year. 

16 ‘‘(e) OTHER DEFINITIONS AND SPECIAL RULES.— 

17 For purposes of this section— 

18 ‘‘(1) EMPLOYEE AND EMPLOYER.— 

19 ‘‘(A) PARTNERS AND PARTNERSHIPS.— 

20 The term ‘employee’ includes a partner and the 

21 term ‘employer’ includes a partnership. 

22 ‘‘(B) CERTAIN RULES TO APPLY.—Rules 

23 similar to the rules of section 52 shall apply. 

24 ‘‘(2) CERTAIN COSTS NOT INCLUDED.—Costs 

25 paid or incurred by an employer for food or health 


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1 insurance shall not be taken into account under sub2 section (a). 

3 ‘‘(3) NO CREDIT WHERE GRANT AWARDED.— 

4 No credit shall be allowable under subsection (a) 

5 with respect to any qualified prevention and wellness 

6 of any taxpayer (other than an eligible employer de7 scribed in subsection (f)(2)(A)) who receives a grant 

8 provided by the United States, a State, or a political 

9 subdivision of a State for use in connection with 

10 such program. The Secretary shall prescribe rules 

11 providing for the waiver of this paragraph with re12 spect to any grant which does not constitute a sig13 nificant portion of the funding for the qualified pre14 vention and wellness. 

15 ‘‘(4) CREDIT PERIOD.— 

16 ‘‘(A) IN GENERAL.—The term ‘credit pe17 riod’ means the period of 10 consecutive taxable 

18 years beginning with the taxable year in which 

19 the qualified prevention and wellness is first 

20 certified under this section. 

21 ‘‘(B) SPECIAL RULE FOR EXISTING PRO22 GRAMS.—In the case of an employer (or prede23 cessor) which operates a prevention and 

24 wellness for its employees on the date of the en25 actment of this section, subparagraph (A) shall 


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1 be applied by substituting ‘3 consecutive taxable 

2 years’ for ‘10 consecutive taxable years’. The 

3 Secretary shall prescribe rules under which this 

4 subsection shall not apply if an employer is re5 quired to make substantial modifications in the 

6 existing prevention and wellness in order to 

7 qualify such program for certification as a 

8 qualified prevention and wellness. 

9 ‘‘(C) CONTROLLED GROUPS.—For pur10 poses of this paragraph, all persons treated as 

11 a single employer under subsection (b), (c), 

12 (m), or (o) of section 414 shall be treated as a 

13 single employer. 

14 ‘‘(f) PORTION OF CREDIT MADE REFUNDABLE.— 

15 ‘‘(1) IN GENERAL.—In the case of an eligible 

16 employer of an employee, the aggregate credits al17 lowed to a taxpayer under subpart C shall be in18 creased by the lesser of— 

19 ‘‘(A) the credit which would be allowed 

20 under this section without regard to this sub21 section and the limitation under section 38(c), 

22 or 

23 ‘‘(B) the amount by which the aggregate 

24 amount of credits allowed by this subpart (de25 termined without regard to this subsection) 


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1 would increase if the limitation imposed by sec2 tion 38(c) for any taxable year were increased 

3 by the amount of employer payroll taxes im4 posed on the taxpayer during the calendar year 

5 in which the taxable year begins. 

6 The amount of the credit allowed under this sub7 section shall not be treated as a credit allowed under 

8 this subpart and shall reduce the amount of the 

9 credit otherwise allowable under subsection (a) with10 out regard to section 38(c). 

11 ‘‘(2) ELIGIBLE EMPLOYER.—For purposes of 

12 this subsection, the term ‘eligible employer’ means 

13 an employer which is— 

14 ‘‘(A) a State or political subdivision there15 of, the District of Columbia, a possession of the 

16 United States, or an agency or instrumentality 

17 of any of the foregoing, or 

18 ‘‘(B) any organization described in section 

19 501(c) of the Internal Revenue Code of 1986 

20 which is exempt from taxation under section 

21 501(a) of such Code. 

22 ‘‘(3) EMPLOYER PAYROLL TAXES.—For pur23 poses of this subsection— 

24 ‘‘(A) IN GENERAL.—The term ‘employer 

25 payroll taxes’ means the taxes imposed by— 


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1 ‘‘(i) section 3111(b), and 

2 ‘‘(ii) sections 3211(a) and 3221(a) 

3 (determined at a rate equal to the rate 

4 under section 3111(b)). 

5 ‘‘(B) SPECIAL RULE.—A rule similar to 

6 the rule of section 24(d)(2)(C) shall apply for 

7 purposes of subparagraph (A). 

8 ‘‘(g) TERMINATION.—This section shall not apply to 

9 any amount paid or incurred after December 31, 2017.’’. 

10 (b) TREATMENT AS GENERAL BUSINESS CREDIT.— 

11 Subsection (b) of section 38 of the Internal Revenue Code 

12 of 1986 (relating to general business credit) is amended 

13 by striking ‘‘plus’’ at the end of paragraph (34), by strik14 ing the period at the end of paragraph (35) and inserting 

15 ‘‘, plus’’, and by adding at the end the following: 

16 ‘‘(36) the prevention and wellness credit deter17 mined under section 45R.’’. 

18 (c) DENIAL OF DOUBLE BENEFIT.—Section 280C of 

19 the Internal Revenue Code of 1986 (relating to certain 

20 expenses for which credits are allowable) is amended by 

21 adding at the end the following new subsection: 

22 ‘‘(g) PREVENTION AND WELLNESS PROGRAM CRED23 IT.— 

24 ‘‘(1) IN GENERAL.—No deduction shall be al25 lowed for that portion of the costs paid or incurred 


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1 for a qualified prevention and wellness (within the 

2 meaning of section 45R) allowable as a deduction for 

3 the taxable year which is equal to the amount of the 

4 credit allowable for the taxable year under section 

5 45R. 

6 ‘‘(2) SIMILAR RULE WHERE TAXPAYER CAP7 ITALIZES RATHER THAN DEDUCTS EXPENSES.—If— 

8 ‘‘(A) the amount of the credit determined 

9 for the taxable year under section 45R, exceeds 

10 ‘‘(B) the amount allowable as a deduction 

11 for such taxable year for a qualified prevention 

12 and wellness, 

13 the amount chargeable to capital account for the 

14 taxable year for such expenses shall be reduced by 

15 the amount of such excess. 

16 ‘‘(3) CONTROLLED GROUPS.—In the case of a 

17 corporation which is a member of a controlled group 

18 of corporations (within the meaning of section 

19 41(f)(5)) or a trade or business which is treated as 

20 being under common control with other trades or 

21 business (within the meaning of section 

22 41(f)(1)(B)), this subsection shall be applied under 

23 rules prescribed by the Secretary similar to the rules 

24 applicable under subparagraphs (A) and (B) of sec25 tion 41(f)(1).’’. 


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1 (d) CLERICAL AMENDMENT.—The table of sections 

2 for subpart D of part IV of subchapter A of chapter 1 

3 of the Internal Revenue Code of 1986 is amended by add4 ing at the end the following: 

‘‘Sec. 45R. Prevention and wellness program credit.’’. 

5 (e) EFFECTIVE DATE.—The amendments made by 

6 this section shall apply to taxable years beginning after 

7 December 31, 2009. 

8 (f) OUTREACH.— 

9 (1) IN GENERAL.—The Secretary of the Treas10 ury, in conjunction with the Director of the Centers 

11 for Disease Control and members of the business 

12 community, shall institute an outreach program to 

13 inform businesses about the availability of the pre14 vention and wellness credit under section 45R of the 

15 Internal Revenue Code of 1986 as well as to educate 

16 businesses on how to develop programs according to 

17 recognized and promising practices and on how to 

18 measure the success of implemented programs. 

19 (2) AUTHORIZATION OF APPROPRIATIONS.— 

20 There are authorized to be appropriated such sums 

21 as are necessary to carry out the outreach program 

22 described in paragraph (1). 


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1 SEC. 4. GRANTS TO INCREASE PHYSICAL ACTIVITY AND 

2 EMOTIONAL WELLNESS, IMPROVE NUTRI3 TION, AND PROMOTE HEALTHY EATING BE4 HAVIORS. 

5 Part Q of title III of the Public Health Service Act 

6 (42 U.S.C. 280h et seq.) is amended by striking section 

7 399W and inserting the following: 

8 ‘‘SEC. 399W. GRANTS TO INCREASE PHYSICAL ACTIVITY 

9 AND EMOTIONAL WELLNESS, IMPROVE NU10 TRITION, AND PROMOTE HEALTHY EATING 

11 BEHAVIORS AND HEALTHY LIVING. 

12 ‘‘(a) ESTABLISHMENT.— 

13 ‘‘(1) IN GENERAL.—The Secretary, acting 

14 through the Director of the Centers for Disease 

15 Control and Prevention and in coordination with the 

16 Administrator of the Health Resources and Services 

17 Administration, the Director of the Indian Health 

18 Service, the Secretary of Education, the Secretary of 

19 Agriculture, the Secretary of the Interior, the Direc20 tor of the National Institutes of Health, the Director 

21 of the Office of Women’s Health, and the heads of 

22 other appropriate agencies, shall award competitive 

23 grants to eligible entities to plan and implement pre24 vention and wellness programs that promote health 

25 and wellness and prevent chronic disease. Such 

26 grants may be awarded to target at-risk populations 


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1 including youth, health disparity populations (as de2 fined in section 485E(d)), and the underserved. 

3 ‘‘(2) TERM.—The Secretary shall award grants 

4 under this subsection for a period not to exceed 4 

5 years. 

6 ‘‘(b) AWARD OF GRANTS.—An eligible entity desiring 

7 a grant under this section shall submit an application to 

8 the Secretary at such time, in such manner, and con9 taining such information as the Secretary may require, in10 cluding— 

11 ‘‘(1) a plan describing a comprehensive pro12 gram of approaches to encourage healthy living, 

13 emotional wellness, healthy eating behaviors, and 

14 healthy levels of physical activity; 

15 ‘‘(2) the manner in which the eligible entity will 

16 coordinate with appropriate State and local authori17 ties and community-based organizations, including 

18 but not limited to— 

19 ‘‘(A) State and local educational agencies; 

20 ‘‘(B) departments of health; 

21 ‘‘(C) State directors of programs under 

22 section 17 of the Child Nutrition Act of 1966 

23 (42 U.S.C. 1786); and 

24 ‘‘(D) community-based organizations serv25 ing youth; and 


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1 ‘‘(3) the manner in which the applicant will 

2 evaluate the effectiveness of the program carried out 

3 under this section. 

4 ‘‘(c) COORDINATION.—In awarding grants under this 

5 section, the Secretary shall ensure that the proposed pro6 grams show a history of addressing these issues, have pro7 gram evaluations that show success, and are coordinated 

8 in substance and format with programs currently funded 

9 through other Federal agencies and operating within the 

10 community. 

11 ‘‘(d) ELIGIBLE ENTITY.—In this section, the term 

12 ‘eligible entity’ means— 

13 ‘‘(1) a city, county, tribe, territory, or State; 

14 ‘‘(2) a State educational agency; 

15 ‘‘(3) a tribal educational agency; 

16 ‘‘(4) a local educational agency; 

17 ‘‘(5) a federally qualified health center (as de18 fined in section 1861(aa)(4) of the Social Security 

19 Act); 

20 ‘‘(6) a rural health clinic; 

21 ‘‘(7) a health department; 

22 ‘‘(8) an Indian Health Service hospital or clinic; 

23 ‘‘(9) an Indian tribal health facility; 

24 ‘‘(10) an urban Indian facility; 

25 ‘‘(11) any health provider; 


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1 ‘‘(12) an accredited university or college; 

2 ‘‘(13) a youth serving organization; 

3 ‘‘(14) a community-based organization; or 

4 ‘‘(15) any other entity determined appropriate 

5 by the Secretary. 

6 ‘‘(e) USE OF FUNDS.—An eligible entity that receives 

7 a grant under this section shall use the funds made avail8 able through the grant to plan and implement prevention 

9 and wellness programs that promote health and wellness 

10 and prevent chronic disease. 

11 ‘‘(f) MATCHING FUNDS.—In awarding grants under 

12 subsection (a), the Secretary may give priority to eligible 

13 entities who provide matching contributions. Such non14 Federal contributions may be cash or in-kind, fairly evalu15 ated, including plant, equipment, training, curriculum, or 

16 a preexisting evaluation framework. 

17 ‘‘(g) TECHNICAL ASSISTANCE.—The Secretary may 

18 set aside an amount not to exceed 10 percent of the total 

19 amount appropriated for a fiscal year under subsection (j) 

20 to permit the Director of the Centers for Disease Control 

21 and Prevention to provide grantees with technical support 

22 in the development, implementation, and evaluation of pre23 vention and wellness programs under this section and to 

24 disseminate information about effective strategies and 


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1 interventions in promoting health and wellness and pre2 venting chronic disease. 

3 ‘‘(h) LIMITATION ON ADMINISTRATIVE COSTS.—An 

4 eligible entity awarded a grant under this section may not 

5 use more than 10 percent of funds awarded under such 

6 grant for administrative expenses. 

7 ‘‘(i) REPORT.—Not later than 6 years after the date 

8 of enactment of this section the Director of the Centers 

9 for Disease Control and Prevention shall review the results 

10 of the grants awarded under this section and other related 

11 research and identify prevention and wellness programs 

12 that have demonstrated effectiveness in promoting health 

13 and wellness and preventing chronic disease. Such review 

14 shall include an identification of model curricula, best 

15 practices, and lessons learned, as well as recommendations 

16 for next steps to promote health and wellness and prevent 

17 chronic disease. Information derived from such review, in18 cluding model prevention and wellness program curricula, 

19 shall be disseminated to the public. 

20 ‘‘(j) DEFINITION.—In this section, the term ‘preven21 tion and wellness program’ means a program that consists 

22 of a combination of activities that are designed to increase 

23 awareness, assess risks, educate, and promote voluntary 

24 behavior change to improve the health of an individual, 

25 modify his or her consumer health behavior, enhance his 


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1 or her personal well-being and productivity, and prevent 

2 illness and injury. 

3 ‘‘(k) AUTHORIZATION OF APPROPRIATIONS.—There 

4 are authorized to be appropriated to carry out this section, 

5 $60,000,000 for fiscal year 2010, and such sums as may 

6 be necessary for each of fiscal years 2011 through 2014.’’. 

7 SEC. 5. PREVENTION AND WELLNESS PROGRAMS FOR INDI8 VIDUALS AND FAMILIES. 

9 (a) IN GENERAL.—The Secretary of Health and 

10 Human Services shall encourage States to work with in11 surance companies on ways to promote and incentivize the 

12 participation of individuals and families in prevention and 

13 wellness programs, such as through insurance premium 

14 reductions. 

15 (b) DEFINITION.—In this section, the term ‘‘preven16 tion and wellness program’’ means a program that con17 sists of a combination of activities that are designed to 

18 increase awareness, assess risks, educate, and promote 

19 voluntary behavior change to improve the health of an in20 dividual, modify his or her consumer health behavior, en21 hance his or her personal well-being and productivity, and 

22 prevent illness and injury. 


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1 SEC. 6. RECOGNIZING FOR WELLNESS PROGRAMS UNDER 

2 GROUP HEALTH PLANS. 

3 (a) PUBLIC HEALTH SERVICE ACT.—Section 2702 of 

4 the Public Health Service Act (42 U.S.C. 300gg–1) is 

5 amended— 

6 (1) in subsection (b), by adding at the end the 

7 following new paragraph: 

8 ‘‘(4) TREATMENT OF WELLNESS PROGRAMS.— 

9 Paragraph (1) shall not be construed as permitting 

10 variation of premiums based on adherence to or par11 ticipation in reasonably designed programs of health 

12 promotion and disease prevention, if such programs 

13 exist and a group health plan (or health insurance 

14 coverage offered in connection with such a plan) 

15 may establish premium discounts or rebates for 

16 modifying otherwise applicable copayments or 

17 deductibles in return for adherence to or participa18 tion in such programs.’’; and 

19 (2) by adding at the end the following new sub20 section: 

21 ‘‘(g) PROGRAMS OF HEALTH PROMOTION OR DIS22 EASE PREVENTION.— 

23 ‘‘(1) GENERAL PROVISIONS.— 

24 ‘‘(A) GENERAL RULE.—For purposes of 

25 this section, a program of health promotion or 

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1 section as a ‘wellness program’) shall be a pro2 gram that is designed to promote health or pre3 vent disease that meets the applicable require4 ments of this subsection. 

5 ‘‘(B) NO CONDITIONS BASED ON HEALTH

6 STATUS FACTOR.—If none of the conditions for 

7 obtaining a premium discount or rebate or 

8 other reward for participation in a wellness pro9 gram is based on an individual satisfying a 

10 standard that is related to a health status fac11 tor, such wellness program shall not violate this 

12 section if participation in the program is made 

13 available to all similarly situated individuals 

14 and the requirements of paragraph (2) are com15 plied with. 

16 ‘‘(C) CONDITIONS BASED ON HEALTH STA17 TUS FACTOR.—If any of the conditions for ob18 taining a premium discount or rebate or other 

19 reward for participation in a wellness program 

20 is based on an individual satisfying a standard 

21 that is related to a health status factor, such 

22 wellness program shall not violate this section if 

23 the requirements of paragraph (3) are complied 

24 with. 


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•HR 3468 IH

1 ‘‘(2) WELLNESS PROGRAMS NOT SUBJECT TO

2 REQUIREMENTS.—If none of the conditions for ob3 taining a premium discount or rebate or other re4 ward under a wellness program as described in para5 graph (1)(B) are based on an individual satisfying 

6 a standard that is related to a health status factor 

7 (or if such a wellness program does not provide such 

8 a reward), the wellness program shall not violate 

9 this section if participation in the program is made 

10 available to all similarly situated individuals. The 

11 following programs shall not have to comply with the 

12 requirements of paragraph (3) if participation in the 

13 program is made available to all similarly situated 

14 individuals: 

15 ‘‘(A) A program that reimburses all or 

16 part of the cost for memberships in a fitness 

17 center. 

18 ‘‘(B) A diagnostic testing program that 

19 provides a reward for participation and does 

20 not base any part of the reward on outcomes. 

21 ‘‘(C) A program that encourages preven22 tive care related to a health condition through 

23 the waiver of the copayment or deductible re24 quirement under an individual or group health 

25 plan for the costs of certain items or services 


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•HR 3468 IH

1 related to a health condition (such as prenatal 

2 care or well-baby visits). 

3 ‘‘(D) A program that reimburses individ4 uals for the costs of smoking cessation pro5 grams without regard to whether the individual 

6 quits smoking. 

7 ‘‘(E) A program that provides a reward to 

8 individuals for attending a periodic health edu9 cation seminar. 

10 ‘‘(3) WELLNESS PROGRAMS SUBJECT TO RE11 QUIREMENTS.—If any of the conditions for obtaining 

12 a premium discount, rebate, or reward under a 

13 wellness program as described in paragraph (1)(C) 

14 is based on an individual satisfying a standard that 

15 is related to a health status factor, the wellness pro16 gram shall not violate this section if the following re17 quirements are complied with: 

18 ‘‘(A) The reward for the wellness program, 

19 together with the reward for other wellness pro20 grams with respect to the plan that requires 

21 satisfaction of a standard related to a health 

22 status factor, shall not exceed 30 percent of the 

23 cost of employee-only coverage under the plan. 

24 If, in addition to employees or individuals, any 

25 class of dependents (such as spouses or spouses 


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•HR 3468 IH

1 and dependent children) may participate fully 

2 in the wellness program, such reward shall not 

3 exceed 30 percent of the cost of the coverage in 

4 which an employee or individual and any de5 pendents are enrolled. For purposes of this 

6 paragraph, the cost of coverage shall be deter7 mined based on the total amount of employer 

8 and employee contributions for the benefit 

9 package under which the employee is (or the 

10 employee and any dependents are) receiving 

11 coverage. A reward may be in the form of a dis12 count or rebate of a premium or contribution, 

13 a waiver of all or part of a cost-sharing mecha14 nism (such as deductibles, copayments, or coin15 surance), the absence of a surcharge, or the 

16 value of a benefit that would otherwise not be 

17 provided under the plan. The Secretaries of 

18 Labor, Health and Human Services, and the 

19 Treasury may increase the reward available 

20 under this subparagraph to up to 50 percent of 

21 the cost of coverage if the Secretaries determine 

22 that such an increase is appropriate. 

23 ‘‘(B) The wellness program shall be rea24 sonably designed to promote health or prevent 

25 disease. A program complies with the preceding 


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•HR 3468 IH

1 sentence if the program has a reasonable 

2 chance of improving the health of, or preventing 

3 disease in, participating individuals and it is 

4 not overly burdensome, is not a subterfuge for 

5 discriminating based on a health status factor, 

6 and is not highly suspect in the method chosen 

7 to promote health or prevent disease. The plan 

8 or issuer shall evaluate the program’s reason9 ableness at least once per year. 

10 ‘‘(C) The plan shall give individuals eligible 

11 for the program the opportunity to qualify for 

12 the reward under the program at least once 

13 each year. 

14 ‘‘(D) The full reward under the wellness 

15 program shall be made available to all similarly 

16 situated individuals. For such purpose, among 

17 other things: 

18 ‘‘(i) The reward is not available to all 

19 similarly situated individuals for a period 

20 unless the wellness program allows— 

21 ‘‘(I) for a reasonable alternative 

22 standard (or waiver of the otherwise 

23 applicable standard) for obtaining the 

24 reward for any individual for whom, 

25 for that period, it is unreasonably difVerDate Nov 24 2008 23:35 Aug 04, 2009 Jkt 079200 PO 00000 Frm 00029 Fmt 6652 Sfmt 6201 E:\BILLS\H3468.IH H3468

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•HR 3468 IH

1 ficult due to a medical condition to 

2 satisfy the otherwise applicable stand3 ard; and 

4 ‘‘(II) for a reasonable alternative 

5 standard (or waiver of the otherwise 

6 applicable standard) for obtaining the 

7 reward for any individual for whom, 

8 for that period, it is medically inadvis9 able to attempt to satisfy the other10 wise applicable standard. 

11 ‘‘(ii) If reasonable under the cir12 cumstances, the plan or issuer may seek 

13 verification, such as a statement from an 

14 individual’s physician, that a health status 

15 factor makes it unreasonably difficult or 

16 medically inadvisable for the individual to 

17 satisfy or attempt to satisfy the otherwise 

18 applicable standard. 

19 ‘‘(E) The plan or issuer involved shall dis20 close in all plan materials describing the terms 

21 of the wellness program the availability of a 

22 reasonable alternative standard (or the possi23 bility of waiver of the otherwise applicable 

24 standard) required under subparagraph (D). If 

25 plan materials disclose that such a program is 


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•HR 3468 IH

1 available, without describing its terms, the dis2 closure under this subparagraph shall not be re3 quired. 

4 ‘‘(4) EXISTING PROGRAMS.—Nothing in this 

5 section shall prohibit a program of health promotion 

6 or disease prevention that was established prior to 

7 the date of enactment of this subsection and applied 

8 with all applicable regulations, and that is operating 

9 on such date, from continuing to be carried out for 

10 as long as such regulations remain in effect. 

11 ‘‘(5) REGULATIONS.—Nothing in this section 

12 shall be construed as prohibiting the Secretaries of 

13 Labor, Health and Human Services, or the Treasury 

14 from promulgating regulations in connection with 

15 this section.’’. 

16 (b) EMPLOYEE RETIREMENT INCOME SECURITY ACT

17 OF 1974.—Section 702 of the Employee Retirement In18 come Security Act of 1974 (29 U.S.C. 1182) is amend19 ed— 

20 (1) in subsection (b), by adding at the end the 

21 following new paragraph: 

22 ‘‘(4) TREATMENT OF WELLNESS PROGRAMS.— 

23 Paragraph (1) shall not be construed as permitting 

24 variation of premiums based on adherence to or par25 ticipation in reasonably designed programs of health 


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•HR 3468 IH

1 promotion and disease prevention, if such programs 

2 exist and a group health plan (or health insurance 

3 coverage offered in connection with such a plan) 

4 may establish premium discounts or rebates for 

5 modifying otherwise applicable copayments or 

6 deductibles in return for adherence to or participa7 tion in such programs.’’; and 

8 (2) by adding at the end the following new sub9 section: 

10 ‘‘(g) PROGRAMS OF HEALTH PROMOTION OR DIS11 EASE PREVENTION.— 

12 ‘‘(1) GENERAL PROVISIONS.— 

13 ‘‘(A) GENERAL RULE.—For purposes of 

14 this section, a program of health promotion or 

15 disease prevention (referred to in this sub16 section as a ‘wellness program’) shall be a pro17 gram that is designed to promote health or pre18 vent disease that meets the applicable require19 ments of this subsection. 

20 ‘‘(B) NO CONDITIONS BASED ON HEALTH

21 STATUS FACTOR.—If none of the conditions for 

22 obtaining a premium discount or rebate or 

23 other reward for participation in a wellness pro24 gram is based on an individual satisfying a 

25 standard that is related to a health status facVerDate Nov 24 2008 23:35 Aug 04, 2009 Jkt 079200 PO 00000 Frm 00032 Fmt 6652 Sfmt 6201 E:\BILLS\H3468.IH H3468

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•HR 3468 IH

1 tor, such wellness program shall not violate this 

2 section if participation in the program is made 

3 available to all similarly situated individuals 

4 and the requirements of paragraph (2) are com5 plied with. 

6 ‘‘(C) CONDITIONS BASED ON HEALTH STA7 TUS FACTOR.—If any of the conditions for ob8 taining a premium discount or rebate or other 

9 reward for participation in a wellness program 

10 is based on an individual satisfying a standard 

11 that is related to a health status factor, such 

12 wellness program shall not violate this section if 

13 the requirements of paragraph (3) are complied 

14 with. 

15 ‘‘(2) WELLNESS PROGRAMS NOT SUBJECT TO

16 REQUIREMENTS.—If none of the conditions for ob17 taining a premium discount or rebate or other re18 ward under a wellness program as described in para19 graph (1)(B) are based on an individual satisfying 

20 a standard that is related to a health status factor 

21 (or if such a wellness program does not provide such 

22 a reward), the wellness program shall not violate 

23 this section if participation in the program is made 

24 available to all similarly situated individuals. The 

25 following programs shall not have to comply with the 


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34 

•HR 3468 IH

1 requirements of paragraph (3) if participation in the 

2 program is made available to all similarly situated 

3 individuals: 

4 ‘‘(A) A program that reimburses all or 

5 part of the cost for memberships in a fitness 

6 center. 

7 ‘‘(B) A diagnostic testing program that 

8 provides a reward for participation and does 

9 not base any part of the reward on outcomes. 

10 ‘‘(C) A program that encourages preven11 tive care related to a health condition through 

12 the waiver of the copayment or deductible re13 quirement under an individual or group health 

14 plan for the costs of certain items or services 

15 related to a health condition (such as prenatal 

16 care or well-baby visits). 

17 ‘‘(D) A program that reimburses individ18 uals for the costs of smoking cessation pro19 grams without regard to whether the individual 

20 quits smoking. 

21 ‘‘(E) A program that provides a reward to 

22 individuals for attending a periodic health edu23 cation seminar. 

24 ‘‘(3) WELLNESS PROGRAMS SUBJECT TO RE25 QUIREMENTS.—If any of the conditions for obtaining 


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35 

•HR 3468 IH

1 a premium discount, rebate, or reward under a 

2 wellness program as described in paragraph (1)(C) 

3 is based on an individual satisfying a standard that 

4 is related to a health status factor, the wellness pro5 gram shall not violate this section if the following re6 quirements are complied with: 

7 ‘‘(A) The reward for the wellness program, 

8 together with the reward for other wellness pro9 grams with respect to the plan that requires 

10 satisfaction of a standard related to a health 

11 status factor, shall not exceed 30 percent of the 

12 cost of employee-only coverage under the plan. 

13 If, in addition to employees or individuals, any 

14 class of dependents (such as spouses or spouses 

15 and dependent children) may participate fully 

16 in the wellness program, such reward shall not 

17 exceed 30 percent of the cost of the coverage in 

18 which an employee or individual and any de19 pendents are enrolled. For purposes of this 

20 paragraph, the cost of coverage shall be deter21 mined based on the total amount of employer 

22 and employee contributions for the benefit 

23 package under which the employee is (or the 

24 employee and any dependents are) receiving 

25 coverage. A reward may be in the form of a disVerDate Nov 24 2008 23:35 Aug 04, 2009 Jkt 079200 PO 00000 Frm 00035 Fmt 6652 Sfmt 6201 E:\BILLS\H3468.IH H3468

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•HR 3468 IH

1 count or rebate of a premium or contribution, 

2 a waiver of all or part of a cost-sharing mecha3 nism (such as deductibles, copayments, or coin4 surance), the absence of a surcharge, or the 

5 value of a benefit that would otherwise not be 

6 provided under the plan. The Secretaries of 

7 Labor, Health and Human Services, and the 

8 Treasury may increase the reward available 

9 under this subparagraph to up to 50 percent of 

10 the cost of coverage if the Secretaries determine 

11 that such an increase is appropriate. 

12 ‘‘(B) The wellness program shall be rea13 sonably designed to promote health or prevent 

14 disease. A program complies with the preceding 

15 sentence if the program has a reasonable 

16 chance of improving the health of, or preventing 

17 disease in, participating individuals and it is 

18 not overly burdensome, is not a subterfuge for 

19 discriminating based on a health status factor, 

20 and is not highly suspect in the method chosen 

21 to promote health or prevent disease. The plan 

22 or issuer shall evaluate the program’s reason23 ableness at least once per year. 

24 ‘‘(C) The plan shall give individuals eligible 

25 for the program the opportunity to qualify for 


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•HR 3468 IH

1 the reward under the program at least once 

2 each year. 

3 ‘‘(D) The full reward under the wellness 

4 program shall be made available to all similarly 

5 situated individuals. For such purpose, among 

6 other things: 

7 ‘‘(i) The reward is not available to all 

8 similarly situated individuals for a period 

9 unless the wellness program allows— 

10 ‘‘(I) for a reasonable alternative 

11 standard (or waiver of the otherwise 

12 applicable standard) for obtaining the 

13 reward for any individual for whom, 

14 for that period, it is unreasonably dif15 ficult due to a medical condition to 

16 satisfy the otherwise applicable stand17 ard; and 

18 ‘‘(II) for a reasonable alternative 

19 standard (or waiver of the otherwise 

20 applicable standard) for obtaining the 

21 reward for any individual for whom, 

22 for that period, it is medically inadvis23 able to attempt to satisfy the other24 wise applicable standard. 


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•HR 3468 IH

1 ‘‘(ii) If reasonable under the cir2 cumstances, the plan or issuer may seek 

3 verification, such as a statement from an 

4 individual’s physician, that a health status 

5 factor makes it unreasonably difficult or 

6 medically inadvisable for the individual to 

7 satisfy or attempt to satisfy the otherwise 

8 applicable standard. 

9 ‘‘(E) The plan or issuer involved shall dis10 close in all plan materials describing the terms 

11 of the wellness program the availability of a 

12 reasonable alternative standard (or the possi13 bility of waiver of the otherwise applicable 

14 standard) required under subparagraph (D). If 

15 plan materials disclose that such a program is 

16 available, without describing its terms, the dis17 closure under this subparagraph shall not be re18 quired. 

19 ‘‘(4) EXISTING PROGRAMS.—Nothing in this 

20 section shall prohibit a program of health promotion 

21 or disease prevention that was established prior to 

22 the date of enactment of this subsection and applied 

23 with all applicable regulations, and that is operating 

24 on such date, from continuing to be carried out for 

25 as long as such regulations remain in effect. 


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•HR 3468 IH

1 ‘‘(5) REGULATIONS.—Nothing in this section 

2 shall be construed as prohibiting the Secretaries of 

3 Labor, Health and Human Services, or the Treasury 

4 from promulgating regulations in connection with 

5 this section.’’. 

6 (c) EFFECTIVE DATE.—The amendments made by 

7 this section shall apply to plan years occurring on or after 

8 the date of the enactment of this Act. 

Æ 


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