Common use of Enhanced Services Clause in Contracts

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 timely manner – Incorporate the most appropriate and farthest-reaching vehicle to communicate the enhanced benefit and incentive so as not to exclude members (e.g., lack of literacy and technology should be considered). Appropriate messaging should capture high quality outcomes; ▪ Be relevant – If barriers exist that prevent members from using the enhanced service and incentive, the incentive will not hold much value (e.g., a member is given a gym membership as an incentive but does not have the transportation to get to the gym). It is important to note the process of designing member enhanced services and incentives is complex and the Contractor will need to consider underlying disparities and social determinants of health including community needs, and local planning efforts. Member enhanced services and incentives must not reinforce disparities or perpetuate inequality within or between communities, particularly in terms of how disparate subpopulations access wellness services and support.

Enhanced Services. The State encourages the Contractor to cover programs that enhance the general health and well-being of its Hoosier Healthwise 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 Hoosier Healthwise 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 6.2.2 and other relevant state and federal rules regarding inducements. inducements All enhanced services offered by the Contractor must shall 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 treatment 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 HIP 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 timely manner – Incorporate the most appropriate and farthest-farthest reaching vehicle to communicate the enhanced benefit and incentive so as not to exclude members (e.g., lack of literacy and technology should be considered). Appropriate messaging should capture high quality outcomes; ▪ Be relevant – If barriers exist that prevent members from using the enhanced service and incentive, the incentive will not hold much value (e.g., a member is given a gym membership as an incentive but does not have the transportation to get to the gym). It is important to note the process of designing member enhanced services and incentives is complex and the Contractor will need to consider underlying disparities and social determinants of health including community needs, and local planning efforts. Member enhanced services and incentives must not reinforce disparities or perpetuate inequality within or between communities, particularly in terms of how disparate subpopulations access wellness services and support.

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, chronic conditions, risk factors or personal responsibility. These enhanced programs and services are above and beyond those covered in the Hoosier Healthwise Care Connect program. In addition, all The Contractor shall provide information on enhanced services shall to be offered. The Contractor must obtain FSSA approval for any proposed enhanced services and must comply with the all member incentives guidelines as set forth in Section 6.2.2 7.2.2 and other relevant state and federal rules law regarding inducements. All enhanced Enhanced services offered associated with a provider claim must be appropriately flagged as such by the Contractor must be pre-approved by FSSA prior health plan to initiating such servicesensure that it is appropriately excluded during the capitation rate setting process. Enhanced services may include, but are not limited to, items such items as: ▪ Incentives for obtaining preventive services; ▪ Enhanced transportation arrangements (i.e., such as transportation to obtain pharmacy services, or 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 patientsworkshops; ▪ Medical equipment or devices not already covered under the Hoosier Healthwise Care Connect 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 timely manner – Incorporate the most appropriate and farthest-farthest reaching vehicle to communicate the enhanced benefit and incentive so as not to exclude members (e.g., lack of literacy and technology should be considered). Appropriate messaging should capture high quality outcomes; ▪ Be relevant – If barriers exist that prevent members from using the enhanced service and incentive, the incentive will not hold much value (e.g., a member is given a gym membership as an incentive but does not have the transportation to get to the gym). It is important to note the process of designing member enhanced services and incentives is complex and the Contractor will need to consider underlying disparities and social determinants of health including community needs, and local planning efforts. Member enhanced services and incentives must not reinforce disparities or perpetuate inequality within or between communities, particularly in terms of how disparate subpopulations access wellness services and support.

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 timely manner – Incorporate the most appropriate and farthest-farthest reaching vehicle to communicate the enhanced benefit and incentive so as not to exclude members (e.g., lack of literacy and technology should be considered). Appropriate messaging should capture high quality outcomes; ▪ • Be relevant – If barriers exist that prevent members from using the enhanced service and incentive, the incentive will not hold much value (e.g., a member is given a gym membership as an incentive but does not have the transportation to get to the gym). It is important to note the process of designing member enhanced services and incentives is complex and the Contractor will need to consider underlying disparities and social determinants of health including community needs, and local planning efforts. Member enhanced services and incentives must not reinforce disparities or perpetuate inequality within or between communities, particularly in terms of how disparate subpopulations access wellness services and support.

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 servicesservices ; ▪ • 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 timely manner – Incorporate the most appropriate and farthest-farthest reaching vehicle to communicate the enhanced benefit and incentive so as not to exclude members (e.g., lack of literacy and technology should be considered). Appropriate messaging should capture high quality outcomes; ▪ • Be relevant – If barriers exist that prevent members from using the enhanced service and incentive, the incentive will not hold much value (e.g., a member is given a gym membership as an incentive but does not have the transportation to get to the gym). It is important to note the process of designing member enhanced services and incentives is complex and the Contractor will need to consider underlying disparities and social determinants of health including community needs, and local planning efforts. Member enhanced services and incentives must not reinforce disparities or perpetuate inequality within or between communities, particularly in terms of how disparate subpopulations access wellness services and support.

Enhanced Services. The State encourages the Contractor to cover programs that enhance the general health and well-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 timely manner – Incorporate the most appropriate and farthest-farthest reaching vehicle to communicate the enhanced benefit and incentive so as not to exclude members (e.g., lack of literacy and technology should be considered). Appropriate messaging should capture high quality outcomes; ▪ Be relevant – If barriers exist that prevent members from using the enhanced service and incentive, the incentive will not hold much value (e.g., a member is given a gym membership as an incentive but does not have the transportation to get to the gym). It is important to note the process of designing member enhanced services and incentives is complex and the Contractor will need to consider underlying disparities and social determinants of health including community needs, and local planning efforts. Member enhanced services and incentives must not reinforce disparities or perpetuate inequality within or between communities, particularly in terms of how disparate subpopulations access wellness services and support.

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, chronic conditions, risk factors or personal responsibility. These enhanced programs and services are above and beyond those covered in the Hoosier Healthwise Care Connect program. In addition, all The Contractor shall provide information on enhanced services shall to be offered. The Contractor must obtain FSSA approval for any proposed enhanced services and must comply with the wit h all member incentives guidelines as set forth in Section 6.2.2 7.2.2 and other relevant state and federal rules law regarding inducements. All enhanced Enhanced services offered associated with a provider claim must be appropriately flagged as such by the Contractor must be pre-approved by FSSA prior health plan to initiating such servicesensure that it is appropriately excluded during the capitation rate setting process. Enhanced services may include, but are not limited to, items such items as: ▪ Incentives for obtaining preventive services; ▪ Enhanced transportation arrangements (i.e., such as transportation to obtain pharmacy services, or 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 patientsworkshops; ▪ Medical equipment or devices not already covered under the Hoosier Healthwise Care Connect 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 timely manner – Incorporate the most appropriate and farthest-farthest reaching vehicle to communicate the enhanced benefit and incentive inc entive so as not to exclude members (e.g., lack of literacy and technology should be considered). Appropriate messaging should capture high quality outcomes; ▪ Be relevant – If barriers exist that prevent members from using the enhanced service and incentive, the incentive will not hold much value (e.g., a member is given a gym membership as an incentive but does not have the transportation to get to the gym). It is important to note the process of designing member enhanced services and incentives is complex and the Contractor will need to consider underlying disparities and social determinants of health including community needs, and local planning efforts. Member enhanced services and incentives must not reinforce disparities or perpetuate inequality within or between communities, particularly in terms of how disparate subpopulations access wellness services and support.

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 timely manner – Incorporate the most appropriate and farthest-farthest reaching vehicle to communicate the enhanced benefit and incentive so as not to exclude members (e.g., lack of literacy and technology should be considered). Appropriate messaging should capture high quality outcomes; ▪ Be relevant – If barriers exist that prevent members from using the enhanced service and incentive, the incentive will not hold much value (e.g., a member is given a gym membership as an incentive but does not have the transportation to get to the gym). It is important to note the process of designing member enhanced services and incentives is complex and the Contractor will need to consider underlying disparities and social determinants of health including community needs, and local planning efforts. Member enhanced services and incentives must not reinforce disparities or perpetuate inequality within or between communities, particularly in terms of how disparate subpopulations access wellness services and support.

Enhanced Services. The State encourages the Contractor to cover programs that enhance the general health and well-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 timely manner – Incorporate the most appropriate and farthest-reaching vehicle to communicate the enhanced benefit and incentive so as not to exclude members (e.g., lack of literacy and technology should be considered). Appropriate messaging should capture high quality outcomes; ▪ Be relevant – If barriers exist that prevent members from using the enhanced service and incentive, the incentive will not hold much value (e.g., a member is given a gym membership as an incentive but does not have the transportation to get to the gym). It is important to note the process of designing member enhanced services and incentives is complex and the Contractor will need to consider underlying disparities and social determinants of health including community needs, and local planning efforts. Member enhanced services and incentives must not reinforce disparities or perpetuate inequality within or between communities, particularly in terms of how disparate subpopulations access wellness services and support.;

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, chronic conditions, risk factors or personal responsibility. These enhanced programs and services are above and beyond those covered in the Hoosier Healthwise Care Connect program. In addition, all The Contractor shall provide information on enhanced services shall to be offered. The Contractor must obtain FSSA approval for any proposed enhanced services and must comply with the all member incentives guidelines as set forth in Section 6.2.2 7.2.2 and other relevant state and federal rules law regarding inducements. All enhanced Enhanced services offered associated with a provider claim must be appropriately flagged as such by the Contractor must be pre-approved by FSSA prior health plan to initiating such services. ensure that it is appropriately excluded during the capitation rate setting process Enhanced services may include, but are not limited to, items such items as: ▪ • Incentives for obtaining preventive services; • Enhanced transportation arrangements (i.e., such as transportation to obtain pharmacy services, or attend member education workshops on nutrition, healthy living, parenting, prenatal classes, etc.)workshops; ▪ 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 Care Connect 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 timely manner – Incorporate the most appropriate and farthest-farthest reaching vehicle to communicate the enhanced benefit and incentive so as not to exclude members (e.g., lack of literacy and technology should be considered). Appropriate messaging should capture high quality outcomes; ▪ Be relevant – If barriers exist that prevent members from using the enhanced service and incentive, the incentive will not hold much value (e.g., a member is given a gym membership as an incentive but does not have the transportation to get to the gym); EXHIBIT 1. It is important to note the process of designing member enhanced services and incentives is complex and the Contractor will need to consider underlying disparities and social determinants of health including community needs, and local planning efforts. Member enhanced services and incentives must not reinforce disparities or perpetuate inequality within or between communities, particularly in terms of how disparate subpopulations access wellness services and support.E SCOPE OF WORK

Enhanced Services. The State encourages the Contractor to cover programs that enhance the general health and well-being of its Hoosier Healthwise 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 Hoosier Healthwise 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 6.2.2 and other relevant state and federal rules regarding inducements. inducements All enhanced services offered by the Contractor must shall 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 treatment 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 HIP 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 timely manner – Incorporate the most appropriate and farthest-reaching vehicle to communicate the enhanced benefit and incentive so as not to exclude members (e.g., lack of literacy and technology should be considered). Appropriate messaging should capture high quality outcomes; ▪ Be relevant – If barriers exist that prevent members from using the enhanced service and incentive, the incentive will not hold much value (e.g., a member is given a gym membership as an incentive but does not have the transportation to get to the gym). It is important to note the process of designing member enhanced services and incentives is complex and the Contractor will need to consider underlying disparities and social determinants of health including community needs, and local planning efforts. Member enhanced services and incentives must not reinforce disparities or perpetuate inequality within or between communities, particularly in terms of how disparate subpopulations access wellness services and support.;