Common use of Enrollment and Practice Discrimination Clause in Contracts

Enrollment and Practice Discrimination. Per 42 CFR 438.3(d), the Contractor shall accept individuals eligible for enrollment in the order in which they apply without restriction. The Contractor shall not, on the basis of health status or need for health care services, discriminate against individuals eligible to enroll. Additionally, the Contractor shall not discriminate against individuals eligible to enroll on the basis of race, color, age, national origin, sex, sexual orientation, gender identity, genetic information, income status, Hoosier Healthwise membership, or disability and will not use any policy or practice that has the effect of discriminating in such manner. Examples of prohibited practices include, but are not limited to, the following: 1. Denying or not providing a member any covered service or access to an available facility, 2. Providing to a member any medically necessary covered service which is different, or is provided in a different manner or at a different time from that provided to other members, other public or private patients or the public at large, except where medically necessary, 3. Subjecting a member to segregation or separate treatment in any manner related to the receipt of any covered service; restricting a member in any way in their enjoyment of any advantage or privilege enjoyed by others receiving any covered service, and 4. Assigning times or places for the provision of services on the basis of the race, color, age, national origin, sexual orientation, gender identity, genetic information, income status, Hoosier Healthwise membership, or disability of the members to be served. The Contractor shall assure members their rights as specified in 42 CFR 438.100. The Contractor shall ensure members and individuals with disabilities are accommodated to actively participate in the provision of services and have physical access to facilities, procedures and exams. For example, the Contractor shall provide appropriate auxiliary aids and services to individuals with impaired sensory, manual, or speaking skills. The Contractor shall provide accommodations to members and individuals with disabilities at no cost to afford such individuals an equal opportunity to benefit from the covered services. If the Contractor knowingly executes a subcontract with a provider with the intent of allowing or permitting the provider to implement barriers to care, (i.e. the terms of the subcontract act to discourage the full utilization of services by some members) the Contractor is in default of its Contract. If the Contractor identifies a problem involving discrimination or accommodations for individuals with disabilities by one of its providers, the Contractor shall promptly intervene and require a corrective action plan from the provider. Failure to take prompt corrective measures may place the Contractor in default of its Contract. Contractor shall also adhere to Section 1557 of the Affordable Care Act / 45 CFR 92.1.

Enrollment and Practice Discrimination. Per 42 CFR 438.3(d), the Contractor shall accept individuals eligible for enrollment in the order in which they apply without restriction. The Contractor shall not, on the basis of health status or need for health care services, discriminate against individuals eligible to enroll. Additionally, the Contractor shall not discriminate against individuals eligible to enroll on the basis of race, color, age, national origin, sex, sexual orientation, gender identity, genetic information, income status, Hoosier Healthwise HIP membership, or disability and will not use any policy or practice that has the effect of discriminating in such manner. Examples of prohibited practices include, but are not limited to, the following: 1. Denying or not providing a member any covered service or access to an available facility, 2. Providing to a member any medically necessary covered service which is different, or is provided in a different manner or at a different time from that provided to other members, other public or private patients or the public at large, except where medically necessary, 3. Subjecting a member to segregation or separate treatment in any manner related to the receipt of any covered service; restricting a member in any way in their enjoyment of any advantage or privilege enjoyed by others receiving any covered service, and 4. Assigning times or places for the provision of services on the basis of the race, color, age, national origin, sexual orientation, gender identity, genetic information, income status, Hoosier Healthwise HIP membership, or disability of the members to be served. The Contractor shall assure members their rights as specified in 42 CFR 438.100. The Contractor shall ensure members and individuals with disabilities are accommodated to actively participate in the provision of services and have physical access to facilities, procedures and exams. For example, the Contractor shall provide appropriate auxiliary aids and services to individuals with impaired sensory, manual, or speaking skills. The Contractor shall provide accommodations to members and individuals with disabilities at no cost to afford such individuals an equal opportunity to benefit from the covered services. If the Contractor knowingly executes a subcontract with a provider with the intent of allowing or permitting the provider to implement barriers to care, (i.e. the terms of the subcontract act to discourage the full utilization of services by some members) the Contractor is in default of its Contract. If the Contractor identifies a problem involving discrimination or accommodations for individuals with disabilities by one of its providers, the Contractor shall promptly intervene and require a corrective action plan from the provider. Failure to take prompt corrective measures may place the Contractor in default of its Contract. Contractor shall also adhere to Section 1557 of the Affordable Care Act / 45 CFR 92.1. Member enrollment with the Contractor will be for the full 12-month calendar year benefit period once the member makes an initial POWER Account contribution. Members will have the opportunity to select a new MCE every year between November 1st to December 15th as part of the open enrollment period.