Comprehensive Wellness Initiative -- Verification of Status

V. Verification of Status

A sample of members who are enrolled in the 80/20 Standard Plan may be tested to verify tobacco use and exemption status in the first program year, July 1, 2010-June 30, 2011. The Plan will contract with a third party vendor to request Physician Certification forms and conduct the tests at times and places to be determined by the Plan. Currently, the Plan is interested in conducting tobacco use verification AWAY from the worksite. The testing activities are paid for by the Plan and results shall remain confidential in accordance with state and federal laws. Consequences related to testing are described in Section VI.

Tobacco Testing

  1. Tobacco use status will be determined by the presence of cotinine, a metabolic byproduct of nicotine, in saliva and blood. The testing methods shall take into account exposure to secondhand smoke.
  2. At the time of testing, members will be asked if they are participating in a NC HealthSmart tobacco cessation or other comparable program. If so, the testing vendor will ask the member to provide the completed Physician Certification Form. The vendor will give the member the form to take to their physician, physician assistant or nurse practitioner for completion. The form is considered complete once a physician certifies the member’s program start date, and signs and dates the form, and once the member has filled in the member section. Members must have started participating in a cessation program prior to the date of testing to be eligible for an exemption.
    1. Members must submit the completed certification form to the testing vendor within fifteen (15) business days from the testing date.
    2. If the testing vendor receives the completed, date appropriate certification form on or before the deadline, members will remain enrolled in the 80/20 Standard Plan for the benefit year.
    3. If the testing vendor does not receive the completed and date appropriate certification form on or before the deadline, members will receive written notification of the consequences outlined in Section VI.
  3. Testing Process
    1. If selected, Members will be notified of the date and location of testing by the testing vendor.
    2. At the time of testing, members will be offered a saliva test that measures only the level of cotinine, a derivative of nicotine, in the body. The member will have the option to observe the testing and see the results of the saliva test at the time of testing.
    3. Members whose results are below the Plan-approved saliva cotinine threshold will remain in the 80/20 Standard Plan for the benefit year.
    4. Members whose results are above the Plan-approved saliva cotinine threshold will be informed of their results and will immediately be offered a second test that measures blood or saliva cotinine levels.
      1. Members whose results are above the Plan-approved saliva cotinine threshold and who refuse the secondary test will be given written notification at the time of testing of the pending consequences of failing the test, their appeal rights, and information on how to appeal. See Sections VI and VII.
      2. Members whose results are above the Plan-approved saliva cotinine threshold and choose to participate in the secondary blood cotinine test will receive their results by mail within one week of the test. See Sections VI and VII.
        1. Members whose secondary test results are below the Plan-approved cotinine threshold will remain in the 80/20 Standard Plan for the benefit year and will receive written confirmation of their status.
        2. Members whose secondary test result is above the Plan-approved cotinine threshold will be mailed written notification of the pending consequences of failing the test, their appeal rights, and information on how to appeal. See Sections VI and VII.
Body Mass Index (BMI) Testing
  1. Members’ height and weight will be measured to verify BMI.  The scale used by the testing vendor will be calibrated routinely and is the final authority on member weight.
    • At the time of testing, members will be asked if they qualify for an exemption due to a medical condition or participation in a NC HealthSmart weight management or other comparable program. If so, the testing vendor will give the member a Physician Certification Form to take to their physician, physician assistant or nurse practitioner for completion. The form is considered complete once a physician certifies that a member has a medical condition that prevents the attainment of the BMI required weight range and/or indicates the member’s start date in the weight management program, and signs and dates the form, and once the member has filled in the member section. Members must have started participating in a weight management program prior to the date of testing to be eligible for an exemption. The exemption certification process for BMI is the same as it is for tobacco which is outlined in Section V 2.
    • Members who refuse the BMI test will be given written notification at the time of testing of the consequences outlined in Section VI.
    • Members whose BMI is less than the specified weight range will remain in the 80/20 Standard Plan for the benefit year.
    • Members whose BMI is equal to or higher than the specified weight range will be notified in writing at the time of testing of their testing results, the pending consequences of failing the test, their appeal rights, and information on how to appeal. See Sections VI and VII.
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