Common use of Enhanced Services Clause in Contracts

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. ‌ 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. ‌ 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’ days advance notice to the Division, the Contractor may modify or eliminate any enhanced expanded 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.