More than just words.

Nomenclature--the system of words we use to describe and define our professional activities--can be critically important to the very survival of the employee assistance concept. EAPA's recent "victory" on the health savings account (HSA) issue provides a dramatic illustration.

As you may remember, health savings accounts were created by U.S. Medicare legislation in 2003 as a tool to reduce healthcare costs. HSAs allow employees and their employers to contribute pre-tax money to pay for future medical expenses. The accounts belong to the employees, who can keep them even if they lose or change jobs. Money invested in the accounts can be carried over from year to year until needed or converted to a retirement fund.

To be eligible for an HSA, an employee must be covered by a "high deductible health plan" (HDHP) but cannot be covered by any other health plan, except for a few" specific exceptions. Earlier this year, the U.S. Treasury Department questioned whether EAPs are health plans. If so, they could not co-exist in an organization with HSAs. Since HSAs are expected to be highly popular, heavily marketed, and appealing to employers as a healthcare cost-containment tool, defining EAPs as health plans would represent a significant threat to the EAP profession in the United States and could lead to companies eliminating their EAPs.

In response to this threat, EAPA submitted a statement to the Treasury Department describing in detail why EAPs are more appropriately defined as workplace services than as health plans. In addition to citing the EAPA definition of employee assistance (including the EAP Core Technology functions), the statement noted that "one of the significant benefits of an EAP is its ability to help individuals sort out the healthcare from the non-healthcare issues and refer the individuals to appropriate multiple resources for needed assistance." EAPA's statement pointed out the following:

   EAPs provide significant services to
   work organizations beyond those
   provided to individual employees
   and family members. In carrying
   out the core functions noted above,
   EAPs have proved invaluable in
   helping organizations prevent and
   respond to workplace violence;
   respond to disasters and other critical
   incidents: manage the disruption
   associated with mergers, acquisitions,
   or downsizing; improve
   workplace safety: increase employee
   morale; and reduce absenteeism,
   mistakes, and healthcare costs.

Based on EAPAs statement and input from many individual EA professionals and allied associations, the Treasury Department issued guidelines in late July confirming that eligibility for an EAP does not preclude eligibility for an HSA as long as the EAP "does not provide significant benefits in the nature of medical care or treatment." The Treasury guidelines also included this clarifying example:

   An employer off-ere a program that
   provides employees with benefits
   under an EAE regardless of enrollment
   in a health plan. The EAP is
   specifically designed to assist the
   employer in improving productivity
   by helping employees identify and
   resolve concerns that affect job performance
   and the work environment.
   The benefits consist primarily
   of free or low-cost confidential
   short-term counseling to identify an
   employee's problem that may affect
   job performance and, when appropriate,
   referrals to an outside organization,
   facility or program to assist
   the employee in resolving the problem.
   The issues addressed during
   the short-term counseling include,
   but are not limited to, substance
   abuse, alcoholism, mental health or
   emotional disorders, financial or
   legal difficulties, and dependent care
   needs. This EAP is not a "health
   plan" under section 223(c)(1)
   because it does not provide significant
   benefits in the nature of medical
   care or treatment.

It is noteworthy that the Treasury guidance does not base its conclusion on the number of sessions an EAP might offer (although it does refer to "short-term counseling"). The Treasury, Department's approach is in line with EAPA's position that the important dimension is the purpose of sessions or contacts with employees, not the number of sessions or contacts.

The HSA issue is a clear example of the importance of being consistent, precise, and thoughtful in our use of professional terminology and the potential consequences of failing to do so. Many in our profession use language such as "utilization rate," "outcome," "network provider," and other terms less than rigorously These are not just words; they are part of our professional nomenclature. We should define, describe, and apply them carefully.

John Maynard is chief executive officer of the Employee Assistance Professionals Association. Contact him by e-mail at [e-mail].