Employee Health Services Handbook

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Chapter 1

Administering Employee Health Programs

Q: May We Establish Employee Health Programs?

Your agency is authorized to establish employee health programs within available appropriations to promote and maintain the physical and mental fitness of employees. Employee health programs are authorized under 5 U.S.C.§7901.

Q: What Constitutes an Employee Health Program?

Employee health programs are most commonly provided to employees through health units located at the workplace. The basic programs include preventive services such as immunizations, physical examinations, and medical screening tests, etc.

Q: What Constitutes an Employee Health Program? (continued)

Over the past few decades, many agencies have expanded the traditional scope of services, and established more comprehensive programs. These programs place more emphasis on physical fitness, health education, intervention activities, and preventive health screenings.

Employee health programs are now widely established and accepted as a valuable resource for enhancing work force effectiveness.

Q: What Services May We Provide?

Agencies are currently offering a wide variety of health services. Your agency chooses the services that best meet its needs. The level of services will vary from agency to agency.

Under 5 U.S.C. §7901, agencies are authorized to offer the following employee health services:

Emergency Response/First Aid

Your agency's qualified medical staff may provide first response and Cardiopulmonary Resuscitation (CPR) for emergencies as well as assessment and initial treatment/first aid to employees who are injured, or become ill during work hours.

Administration of Treatments and Medications

If furnished by the employee and prescribed in writing by his/her personal physician, your agency's qualified medical staff may administer treatment/medication during working hours.

Physical Examinations

Your agency's qualified medical staff may administer properly authorized pre-placement and periodic physical examinations to assess an employee's health status. Based on the results of the exam and/or testing, medical staff may refer employees to the Employee Assistance Program (EAP), private physicians, dentists, and other community health resources.

Environmental Health Hazards Appraisals

Your agency may appraise and report work environment health hazards to department management as an aid in preventing and controlling health risks.

Health Education

Your agency may provide health education to encourage employees to maintain a healthy lifestyle, to understand their risk for disease, and to become aware of appropriate preventive practices. For example, your agency may provide health education through health questionnaires, health risk appraisals, health fairs, newsletters, brochures, and presentations.

Health Services/ Intervention Programs

Your agency may provide health intervention programs to promote and maintain physical and mental fitness and to help prevent illness and disease. Health Services/ Intervention Programs encourage and enable employees to initiate healthy behavior changes. Your agency may offer group activities and classes, individual counseling, demonstrations, and self help materials.

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Q: What Services May We Provide?

Disease Screening Examinations and Immunizations

Specific preventive health screenings or examinations may be sponsored at the workplace to detect the presence or risk of disease. Common workplace screenings include exams for blood pressure, mammography, blood lipids, glucose, vision and hearing. Medical staff may provide employees with immunizations, such as influenza and tetanus.

Physical Fitness Programs and Facilities

Your agency may establish and operate physical fitness programs and facilities designed to promote and maintain employee health. Your agency may establish on-site fitness facilities or use the services of a private facility. Activities may be offered without special facilities.

Fitness programs include activities such as walking clubs/events, aerobic exercise classes, weight lifting instruction, stretching classes, fun runs, lectures on safe participation, and fitness assessments.

Fitness assessments are physical tests that assess an employee's level of fitness as compared to his/her peers. The fitness assessment might include a one-minute sit up and push up test, 1.5 mile run, sit-and-reach flexibility test, body fat analysis, and three-minute step test.

Public Access Defibrillation Programs

Federal agencies electing to establish a public access defibrillation program in a Federal facility must follow the guidelines contained in "Guidelines for Public Access Defibrillation Programs in Federal Facilities," a product collaboratively produced by the General Services Administration and the Department of Health and Human Services. The guidebook may be obtained through a search from www.gsa.gov, by calling 202-501-1731, or by writing the Office of Real Property (MP), General Services Administration, 1800 F Street, NW, Washington, DC 20405.

Q: What are the Agency's Responsibilities?

• Determine the need for and extent of employee health programs
• Assess employee health needs and interests
• Assess and provide management support
• Assess the health policies and philosophies of the organization
• Identify available resources
• Integrate the program with other organization functions
• Determine the method for operation
• Establish a statement of goals and objectives
• Direct and monitor programs and services
• Assure that programs are safe, appropriate, and meet legal and ethical requirements
• Select qualified personnel
• Develop a program calendar
• Establish a marketing strategy to reach all employees
• Make services convenient and available to all employees
• Develop an ongoing evaluation process
• Revise and improve the program
• Negotiate or consult with unions, as appropriate, on providing services for bargaining unit employees.

*For agencies in GSA-controlled space establishing health services programs, consult the GSA Customer Guide to Real Property, a publication of the Public Building Service. Search the GSA website at www.gsa.gov or call 202-501-1100.

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Q: How Are Employee Health Programs Administered?

Your agency must determine the best way to provide employee health programs based on the scope of the program and available resources. The level of services and methods for administering programs will be particular to your agency.

Scope

Your program may be comprehensive or single-focused. According to the Department of Health and Human Service's Healthy People 2010, comprehensive programs must have the following elements:

• Health education
• Supportive social and work environment
• Integration into the organization's administrative structure
• Related programs such as Employee Assistance Programs
• Screening programs with follow-up

Available Resources

The availability of resources (funding, space, and staff) will define the type of programs your agency can offer. Your program can be:

• Fully funded by the agency
• Funded by a combination of employee fees and agency funding
• Fully funded by employee contributions or fees.
• Remember that many successful programs run on small budgets.

Q: May Agencies Share Employee Health Programs?

Single Agency/Multi-Agency Program

Depending on its size and mission, your agency must determine whether to create its own program or share services with other agencies. Sometimes it is more cost effective to share employee health services and facilities with other agencies in the same building or geographic location. This can be done through interagency agreements or consortia.

Interagency Agreements

To share services, your agency may enter into an interagency agreement on a reimbursable basis with another Federal agency. This process offers a convenient alternative to contracting and is often quicker and less cumbersome than the contracting process. As with contracting, your agency may choose to use one agreement to provide either all of its employee health services or just specific services such as periodic examinations.

Related Guidance

The Economy Act, 31 U.S.C. §1535, gives agencies authority to enter into interagency agreements with other Federal agencies.

Consortia

When no single agency can serve as a provider for smaller neighboring agencies, the combined employee populations may contract for a consortium for a single health program to provide to participating agency employees.

One lead agency generally serves as the contracting agency. The lead agency enters into a contract or agreement with a service provider. Participating agencies are linked to the contract via an interagency agreement with the lead agency. Work with your contracting office for appropriate contracting procedures.

Your agency may use the Cooperative Administrative Support Unit (CASU) program of the General Services Administration as another type of consortium. CASU organizations establish the legal and administrative framework for Federal offices to share services (including health and fitness centers and health services).

Under this option, Federal tenants, located in the same or nearby facilities, establish and manage an administrative support unit that provides commonly needed services on a reimbursable basis. Such services may include, among others, health and fitness facilities and services. A tenant Board of Directors guides each local CASU. The CASU organization contracts with a vendor to provide the needed services. For further details, agencies can contact GSA's Telework and Innovative Workplaces and CASU at 202-273-4660.

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Q: How Do We Staff and Manage Our Employee Health Programs?

Your agency may choose to staff and manage your employee health programs from a variety of options. Your agency should ensure that the staff persons delivering health services are qualified and trained.

Agency Personnel

Your agency may hire employees or use existing agency personnel to develop, manage, and deliver programs. The staff may be employed either full time, part-time, or assigned the duties on a collateral basis. Many agencies organize all of their employee health staff and programs into one division for more efficient coordination. Sometimes agencies form employee health committees with representatives from various offices to integrate services, coordinate, and promote programs.

Contractor

Contracting with qualified vendors to develop, manage, and deliver programs is a viable option for many agencies. Your agency might find a vendor through:

• Commercial health clubs
• Community centers
• Local hospitals
• Non-profit organizations
• Private consultants
• Universities.

Your agency might choose to use one contractor to provide a comprehensive program or contract for a specific service such as a health risk appraisal program or an annual health fair. Contact your contracting office for appropriate contracting procedures.

Volunteer

Your agency may also provide many health activities through volunteer or no-cost arrangements.

A qualified volunteer employee might give a lunch time presentation on preparing for a 10K run. An intern from a local university could conduct fitness evaluations. A volunteer employee wellness committee could organize a lunchtime walking club.

A non-profit health organization might provide free speakers for a wellness education series. Many of these local organizations provide free materials such as pamphlets, videos, and posters, especially if they tie in to a national health campaign such as the Great American Smokeout.

Many agencies with offices across the country rely on volunteer employees to coordinate and communicate health promotion activities. Your agency should ensure that volunteers have the skill, qualifications, and knowledge to deliver health activities.

Federal Occupational Health

Many agencies use the services of Federal Occupational Health (FOH) of the U.S. Public Health Service. FOH can provide clinical services, environmental health services, on-site health clinics, wellness/fitness centers, and employee assistance programs to Federal agencies via interagency agreements. Call 1-800-457-9808, or visit www.foh.dhhs.gov.

Non-Profit Employee Organization

In many agencies, employees form non-profit employee organizations such as a recreation association or an employee board to manage fitness facilities or administer health activities.

An employee organization is comprised of interested employees who deliver organized activities and programs for their fellow employees in a structured format supported by company management. An employee organization may hire its own staff or use vendors to provide services. The organization collects fees from participating employees to cover the operating costs.

Your agency may provide Government resources to support employee organizations in accordance with appropriate General Services Administration regulations contained in Title 41 of the Code of Federal Regulations. The agency may pay for the rent and maintenance of space, and the start-up costs of fitness facilities managed by employee organizations. If there are membership costs, your agency may arrange fee collection through payroll deduction.

For more information on fee collection, see Chapter 2, Providing Physical Fitness Programs.

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Related Guidance

5 CFR Part 251 provides regulations governing agency relations with managerial, supervisory, professional, and other organizations that are not labor organizations.

Section 251.101 (d) of 5 CFR Part 251 cautions that "an agency's consultation and communication with organizations representing Federal employees...may not take on the character of negotiations or consultations regarding conditions of employment of bargaining unit employees, which is reserved exclusively to labor organizations as provided for in Chapter 71 of title 5 of the U.S. Code..." (5 CFR 251 does not mandate the establishment of relationships with non-labor organizations, other than supervisory/managerial associations.)

Q: Do We Need Special Facilities to Provide Employee Health Programs?

Employee health programs and activities require different types of space and facilities. Agencies may use existing space for educational seminars, meetings, health assessments, or a video/health education library, for example. Your agency is authorized to establish on-site health and fitness facilities and health units. The General Services Administration provides or arranges for space and equipment for EAPs, health units, and fitness facilities in Federally owned and leased buildings.

Health and Fitness Facilities

Your agency is authorized to establish an on-site fitness facility for its employees for physical fitness activities, comprehensive health education and intervention activities, as well as health screenings.

For more information about on-site facilities, see Chapter 2, Providing Physical Fitness Programs.

Health Units

Since 1946, the health unit has been the most common site for providing health services to Federal employees. A health unit or occupational health center (OHC) is a convenient place to provide and coordinate comprehensive health services. Providing services at or near the workplace minimizes employees' time away from work and enhances productivity.

Depending on the size and needs of the agency(s) served, your agency may provide full-or part-time health services. Smaller agencies within a building or geographic locality may share space and/or services or have access to a nearby off-site health center.

Coordinate the design and plans for a new OHC in Government owned or leased space with GSA regional offices. Federal Occupational Health can also help review space, supplies, and equipment needs based on your agency's population and services.

Your agency or vendor may manage the ongoing operations of the OHC which may be staffed with contracted health professionals. An occupational health registered nurse is recommended, however, occupational health physicians, physician's assistants, nurse practitioners, licensed practical nurses, and trained technicians may all be appropriate depending on the size, scope, and complexity of the services required.

Consider the OHC when developing any agency employee health program plan. The OHC staff should work in conjunction with your agency's on-site fitness facility, employee assistance counselors, and health and safety professionals. The OHC and its staff can play a pivotal role in the effectiveness and success of your agency's employee health services program.

For Further Information

Call Federal Occupational Health Customer Assistance at 800-457-9808. FOH has published Standards & Criteria for the Development of Comprehensive Occupational Health Programs.

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Q: What are Key Elements of a Successful Employee Health Program?

There are many excellent resource books on developing successful employee health programs. Most strategies can apply in general to most worksites. Federal employee health programs have evolved for many years and have unique challenges.

Successful Federal programs have firmly planted roots and have a plan to manage ongoing changes in program needs and management support. Consider these strategies:

• Integrate with other agency programs to provide streamlined coordinated services. Some agencies combine their employee health, employee assistance, and work/life programs under one division.
• Update your program to meet the current health needs and interests of employees and the agency. For example, during downsizing, employees may be more in need of stress management, humor therapy, and physical fitness than cholesterol screenings.
• Look at more effective ways to deliver services. If employees are too busy to visit your health facility, bring programs and information to them via computer technology.
• Focus on quality over quantity.
• Continue to evaluate your programs and eliminate ineffective or costly programs.
• Look for ways to share costs with employees. Many Federal fitness centers have survived ongoing budget cuts because they are funded through employee membership fees.

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Q: What Kinds of Work and Leave Flexibilities May Agencies Provide to Employees to Participate in Employee Health Programs?

The Federal personnel system gives employees considerable flexibility in scheduling their hours of work and taking time off for routine medical examinations and preventive screenings. Agencies should review policies and make maximum use of existing work schedules to encourage employees to take advantage of preventive health services. The following are some examples of the work and leave flexibilities available to employees:

Alternative Work Schedules

Your agency may establish flexible or compressed work schedules, collectively referred to as "alternative work schedules." Alternative work schedules allow for a variety of working arrangements tailored to individual employee needs.

Excused Absence

Most employees accrue 13, 20, or 26 days of annual leave each year, depending on years of service (which accumulates to a maximum of 240 hours each year).

Your agency may grant a limited amount of excused absence to employees to participate in agency sponsored preventive health activities, such as health fairs, mobile health van screenings, and smoking cessation and stress reduction classes.

Sick Leave

Most employees accrue 13 days of sick leave each year without regard to length of service. This sick leave accumulates without limit in succeeding years.

Advance Leave

Supervisors may advance annual and/or sick leave to employees who do not have available paid leave for health services not directly sponsored by the agency. Supervisors may also advance annual leave to employees for any additional examinations and follow-up treatments.

When an employee needs additional medical attention, e.g., for a serious health condition identified by a screening process, two additional leave programs are available.

The Family and Medical Leave Act of 1993 (FMLA)

Under the FMLA, an employee is entitled to a total of 12 work weeks of unpaid leave during any 12-month period for certain need, including an employee's serious health condition and screenings for such conditions. FMLA leave may be used intermittently and is in addition to other paid time off available to an employee. Employees may substitute sick or annual leave for unpaid leave under the FMLA.

Leave Sharing

Employees who experience a medical emergency identified through a preventive health screening and who exhaust their available paid leave may receive donated annual leave from other Federal employees through the voluntary leave transfer and leave bank programs. Employees may not use donated annual leave to participate in employee health programs.

Additional information on Federal leave programs may be found at OPM's website at www.opm.gov/oca/leave/.

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