Enhanced Services. The State encourages the Contractor to cover programs that enhance the general health and well-being of its Hoosier Healthwise members, including programs that address preventive health, risk factors or personal responsibility. These enhanced programs and services are above and beyond those covered in the Hoosier Healthwise program. In addition, all enhanced services shall comply with the member incentives guidelines set forth in Section 6.2.2 and other relevant state and federal rules regarding inducements. All enhanced services offered by the Contractor must be pre-approved by OMPP prior to initiating such services. Enhanced services may include, but are not limited to, such items as:
Enhanced Services. 5.1 The ICB must manage the design (where applicable) and commissioning of any Enhanced Services, including re-commissioning these services annually where appropriate.
5.2 The ICB may consider any local enhanced services entered into with Primary Medical Services Providers in its Area using NHS Standard Contracts. Where these would continue to be beneficial to the Area, the ICB may manage the ongoing design and commissioning (including re-commissioning) of these services via a Local Incentives Scheme.
5.3 The ICB must ensure that it complies with any Mandated Guidance in relation to the design and commissioning of Enhanced Services.
5.4 When commissioning newly designed Enhanced Services the ICB must:
5.4.1 consider the needs of the local population in the Area;
5.4.2 develop the necessary specifications and templates for the Enhanced Services, as required to meet the needs of the local population in the Area;
5.4.3 when developing the necessary specifications and templates for the Enhanced Services, ensure that value for money will be obtained;
5.4.4 consult with Local Medical Committees and other stakeholders and comply with the duty of public involvement and consultation under section 14Z45 of the NHS Act;
5.4.5 liaise with system providers and representative bodies to ensure that the system in relation to the Directed Enhanced Services, NHS England Enhanced Services and Local Enhanced Services will be functional and secure;
5.4.6 support Data Controllers in providing ‘fair processing’ information as required by the UK GDPR; and
5.4.7 support Primary Medical Services Providers in entering into data processing agreements with data processors in the terms required by the UK GDPR.
Enhanced Services. The CCG must manage the design and commissioning of Enhanced Services, including re-commissioning these services annually where appropriate.
Enhanced Services. One of the goals of EOHHS is to reduce barriers to care that exist in the fee-for-service delivery system. To accomplish this goal, the Contractor agrees to offer a schedule of enhanced services, as described below.
Enhanced Services. The State encourages the Contractor to cover programs that enhance the general health and well-being of its Hoosier Healthwise members, including programs that address preventive health, risk factors or personal responsibility. These enhanced programs and services are above and beyond those covered in the Hoosier Healthwise program. In addition, all enhanced services shall comply with the member incentives guidelines set forth in Section 6.2.2 and other relevant state and federal rules regarding inducements. All enhanced services offered by the Contractor must be pre-approved by FSSA prior to initiating such services. Enhanced services may include, but are not limited to, such items as: ▪ Enhanced transportation arrangements (i.e., transportation to obtain pharmacy services, attend member education workshops on nutrition, healthy living, parenting, prenatal classes, etc.); ▪ Enhanced tobacco dependence treatment services; ▪ Disease management programs or incentives beyond those required by the State; ▪ Healthy lifestyles incentives; ▪ Group visits with nurse educators and other patients; ▪ Medical equipment or devices not already covered under the Hoosier Healthwise program to assist in prevention, wellness, or management of chronic conditions; and ▪ Cost effective supplemental services which can provide services in a less restrictive setting. While member enhancements and incentives can be powerful tools, these programs need to be thoughtfully designed to ensure there are no unintended consequences, for example increasing disparities or limiting access. To this end, the State has developed guidance to encourage the Contractor to consider the following set of guiding principles in their design and implementation as building blocks of member enhancements and incentives: ▪ Culturally sensitive – Ensuring cultural sensitivity is necessary to provide successful outcomes, as cultural norms differ and may need to be incentivized differently; ▪ Unbiased – Creating unbiased enhancements and incentives are necessary to comply with federal laws. Incentives must not leave out any groups on the basis of ethnicity, education, race, social class, ability, etc.); ▪ Possess equity – Equality is not enough when providing enhanced services and incentives, rather maintaining equity should also be considered (equality would be providing a pair of size 10 shoes to everyone; equity is providing a pair of the correct size shoes to everyone); ▪ Communicated appropriately in a tim...
Enhanced Services. The State encourages the Contractor to cover programs that enhance the general health and well-being of its HIP members, including programs that address preventive health, risk factors or personal responsibility. These enhanced programs and services are above and beyond those covered in the HIP program. For enhanced services developed for HIP, the enhancements shall be developed to align with the overall program goals aimed at creating a commercial market experience and encouraging member participation in HIP Plus. Therefore, enhanced benefits and services shall only be offered to HIP Plus and HIP State Plan Plus members. Notwithstanding the foregoing, the Contractor may elect to provide enhanced benefits and services to HIP Basic and HIP State Plan Basic members, provided that such benefits and services are not applied against the member’s POWER Account. In addition, all enhanced services shall comply with the member incentives guidelines set forth in Section 9.2.2 and other relevant state and federal rules regarding inducements All enhanced services offered by the Contractor shall be pre-approved by OMPP prior to initiating such services. Enhanced services may include, but are not limited to, such items as:
Enhanced Services. The Contractor may provide enhanced services that exceed the benefits or services provided under the Mississippi Fee-for-Service delivery system, subject to advance written approval by the Division. Any enhanced services must fully comply with the provisions of 42 C.F.R. § 438.3(e). Enhanced services are generally considered to have a direct relationship to the maintenance or enhancement of a Member’s health status. Examples of potentially approvable services include various seminars and educational programs promoting healthy living or illness prevention, memberships in health clubs and/or facilities promoting physical fitness and expanded eyeglass or eye care benefits. These services must be generally available to all Members, and may not be tied to specific Member performance without Division prior approval. The Division may grant exceptions in areas where it believes that such tie-ins shall produce significant health improvements for Members. The Contractor may only include information in Member communications about enhanced services that will apply for a minimum of one full year or until the Member information is revised, whichever is later. Upon sixty (60) calendar days’ advance notice to the Division, the Contractor may modify or eliminate any enhanced services. The Contractor must send written notice to Members and affected Providers at least thirty (30) calendar days prior to the effective date of the change in covered services and must simultaneously amend all written materials describing its covered benefits or Provider Network. If the Contractor elects to provide enhanced services, it shall submit a statement annually as to the value of these services within thirty (30) calendar days of request from the Division or its Agent in a format to be specified by the Division. The utilization and actual cost of enhanced services are taken into account in developing the component of the capitation rates that represents the covered State plan services.
Enhanced Services. 4.5.3.1 In addition to the Covered Services provided above, the Contractor shall do the following:
4.5.3.1.1 Place strong emphasis on programs to enhance the general health and well-being of Members;
4.5.3.1.2 Make health promotion materials available to Members;
4.5.3.1.3 Participate in community-sponsored health fairs; and
4.5.3.1.4 Provide education to Members, families and other Health Care Providers about early intervention and management strategies for various illnesses.
4.5.3.2 The Contractor shall not charge a Member for participating in health education services that are defined as either enhanced or Covered Services.
Enhanced Services. A Party may individually enhance the level of Baseline Services provided by the Authority to that Party at an additional cost. The enhancement, cost, and start date of the new enhanced service (“Enhanced Services”) are subject to pre-approval by the Board. The additional fee for Enhanced Services will accrue as of the date such services begin and be due and payable as part of that Party’s Member Fee as provided for in this 2019 Agreement or, in the case of a Party that is part of the Service Area, a separate Enhanced Services fee paid separately to UFA by the Party receiving such services.
Enhanced Services. Refers to services, offered over common carrier transmission facilities, which employ computer processing applications that act on the format, content, code, protocol or similar aspects of the subscriber’s transmitted information; provide the subscriber additional, different, or restructured information; or involve subscriber interaction with stored information. In addition, and without limiting the foregoing, internet, information services, voicemail, and so-called “chat line” services are Enhanced Services, of which the voice or TDM component both originates and terminates within the local calling area as defined by Frontier’s tariffs. If the voice or TDM component does not both originate and terminate within such local calling area, the traffic shall not be covered by this Agreement and shall be subject to interstate or intrastate access tariffs depending on the geographic points of voice or TDM origination and termination.
