Expanded Services. The PH-MCO may provide expanded services subject to advance written approval by the Department. These must be services that are generally considered to have a direct relationship to the maintenance or enhancement of a Member’s health status, and may include various seminars and educational programs promoting healthy living or illness prevention, memberships in health clubs and facilities promoting physical fitness and expanded eyeglass or eye care benefits. These services must be generally available to all Members and must be made available at all appropriate Network Providers. Such services cannot be tied to specific Member performance; however, the Department may grant exceptions when it believes that such performance will produce significant health improvements for Members. Previously approved services will continue to remain in effect under this Agreement, unless the PH- MCO is notified, in writing, by the Department, to discontinue the expanded service. In order for information about expanded services to be included in any Member information provided by the PH-MCO, the PH-MCO must make the expanded services available for a minimum of one full year or until the Member information is revised, whichever is later. Upon sixty (60) days advance notice to the Department, the PH- MCO may modify or eliminate any expanded service. Such services as modified or eliminated shall supersede those specified in the Proposal. The PH-MCO must send written notice to Members and affected Providers at least thirty (30) days prior to the effective date of the change in covered services and must simultaneously amend all written materials describing its covered services or Provider Network. A change in covered services includes any reduction in services or a substantial change to the Provider Network.
Expanded Services. The PH-MCO may offer Members consumer incentives only if they are directly related to improving health outcomes. The incentive cannot be used to influence a Member to receive any item or service from a particular Provider, practitioner or supplier. In addition, the incentive cannot exceed the total cost of the service being provided. The PH-MCO must receive advance written approval from the Department prior to offering a Member incentive.
Expanded Services. A Health Plan Covered Service for which the Health Plan receives no direct payment from the Agency.
Expanded Services. The contractor may elect to provide expanded services. If the contractor elects to provide expanded services, the services must be offered to all eligible enrollees following written approval by the Department of Elder Affairs. Expanded services are defined as the following:
(1) Services in excess of the amount, duration and scope of those listed in Section 1.3.3 contract Terms and Conditions; and
(2) Services and benefits not listed in Paragraph 1.3.3, Contract Terms and Conditions.
Expanded Services. 1. The following services are defined as Expanded Services that may be offered by the Health Plan following the Agency’s written approval:
a. Services in excess of the amount, duration and scope of those listed in Section V, Covered Services;
b. Services and benefits not listed in Section V, Covered Services;
c. The Health Plan may offer, upon written Agency approval, an over-the-counter expanded drug benefit, not to exceed twenty-five dollars ($25.00) per household, per month. Such benefits shall be limited to nonprescription drugs containing a national drug code ("NDC") number, first aid supplies and birth control supplies. Such benefits must be offered directly through the Health Plan's fulfillment house or through a Subcontractor. The Health Plan shall make payments for the over-the-counter drug benefit directly to the Subcontractor, if applicable.
2. The following is a list of the Health Plan’s Expanded Services:
a. Annual comprehensive oral exam, x-rays (one per year), 2 cleanings per year, silver amalgam fillings, one peridontic deep cleaning per year, 2 peridontic scaling and root planning per year;
b. Unlimited eye exams and eyeglasses, if medically necessary;
c. Up to $25 credit per household each month for selected over the counter drugs and/or health supplies;
d. Free approved round trip transportation to medical appointments;
e. Hearing exam and one hearing aid every three years, if medically necessary (hearing aid only).
f. Circumcision up to 1 year.
Expanded Services. A PSN covered service for which the PSN receives no direct payment from the Agency.
Expanded Services. (See Attachment I)
1. The following services are defined as expanded services that may be offered by the Health Plan. The Health Plan shall define the services specifically in writing and submit them to HSD for approval before implementation.
a. Services in excess of the amount, duration and scope of those listed in Attachment II, Section V, Covered Services, and Section VI, Behavioral Health Care;
b. Services and benefits not listed in Attachment II, Section V, Covered Services, or Section VI, Behavioral Health Care; WellCare of Florida, Inc., Medicaid HMO Non-Reform Contract
c. The Health Plan may offer, upon written Agency approval, an over-the-counter expanded drug benefit, not to exceed twenty-five dollars ($25) per household, per month. Such benefits shall be limited to nonprescription drugs containing a national drug code (NDC) number, first aid supplies and birth control supplies. Such benefits must be offered directly through the Health Plan's fulfillment house or through a subcontractor. The Health Plan shall make payments for the over-the-counter drug benefit directly to the subcontractor, if applicable.
d. Adult Dental Services – routine preventive services, diagnostic and restorative services, radiology services and discounts on dental services;
e. Adult Vision Services – eye exams, eyeglasses and contact lenses;
f. Adult Hearing Services – hearing evaluations, hearing aid devices and hearing aid repairs.
2. The Health Plan’s approved expanded services under this Contract are listed in Attachment I.
Expanded Services. To allow the State to make payments for services that will be provided that are not normally covered under Part E of title IV of the Act; and to allow the State to use title IV-E funds for these costs and services as described in the Terms and Conditions, Section 2.0.
4. All waivers are granted only to the extent necessary to accomplish the project as described in the Terms and Conditions. The Lead Agency agrees that its compliance with the Terms and Conditions referenced above is fundamental to the implementation of the Waiver authority. The Lead Agency recognizes that failure to operate the demonstration as approved and according to Federal and State statutes and regulations may result in withdrawal of waiver authority.
Expanded Services. The Scope of Services in Original Agreement for Phase I is expanded to include the additional work described in “Change Order Request No. 1” attached hereto as Exhibit 3 and made a part of this Addendum. This change order is an addition to the rest of the Scope of Services of Original Agreement.
Expanded Services. The contractor may offer incentive programs for enrollees. The contractor shall receive written approval from the department prior to the use of any special incentives for enrollees. Any incentive program offered must be provided to all eligible individuals and will not be used to direct individuals to select a specific contractor.