Health-Related Services and Activities

100.1 – Health-Related Services and Activities (Rev. 121, Issued: 04-22-16, Effective: 04-22-16, Implementation: 04-22-16) MA plans have significant flexibility in designing RI Programs that are specific to their populations’ interests, abilities and needs. Plans are free to determine the specific services, activities, or behaviors that are subject to rewards or incentives within their RI Program design. Health-related services and activities associated with an RI Program may include, for example, the utilization of a particular service(s) or preventive screening benefit(s), adherence to prescribed treatment regimens, attending education/self-care management lessons, meeting nutritional goals, and making and keeping appointments with the doctor. Plans may not discriminate based on health status, therefore, rewards and incentives based on health outcomes may not be offered. However, enrollees may be rewarded for continued healthy behaviors over time. For example, plans may not provide rewards and incentives for the amount of weight lost or a lowered blood pressure, as those are health outcomes and health status factors. Instead, the plan may provide rewards and/or incentives to enrollees for reporting their weights or blood pressures at regular intervals. Plans also may reward sustained behavior changes by enrollees in order to support and promote the ultimate goal of RI Programs, which is lasting, positive changes in health- related behaviors. For example, an RI Program might include rewards and incentives for those enrollees that report that they remain smoke-free at several time intervals after completion of a smoking cessation program. Note: Completion of a federally mandated survey, though arguably a health-related activity, may not be included in an RI Program because of the potential for biased responses due to the influence of rewards or incentives.