Prevention programs that help people develop a wider range of competencies, such as interpersonal skills training or marriage education, are considered direct community services.
Direct services are those that are delivered directly to customers. "Direct services" are services that are not given to residents, patients, tenants, or participants of the provider by people such as building contractors, repair workers, or other people who are only in the program temporarily, on an irregular basis, and do not give any treatment or services to them.
Services provided directly to a patient by a health insurer, a health care professional, a facility, or another provider are referred to as direct services.
These services include case management, disease management, health education and promotion, preventive services, quality incentive payments to providers, and any portion of an assessment that covers services rather than administration and for which an insurer is not eligible for a tax credit under the Medical Insurance Pool Act or the Health Insurance.
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<span><span>In the early weeks of the administration of President Benjamin Harrison (1889-1893), the U.S. minister to Hawaii, Henry Carter, drafted a free-trade treaty with Hawaii. The treaty intended to transform the island nation into an American protectorate: the United States would guarantee Hawaii’s independence at the price of American veto power over treaties Hawaii negotiated with other countries and American military authority over internal or external threats. When a rebellion broke out in July 1889, Harrison ordered 70 marines to land and restore order in Hawaii, and thereafter stationed an American naval vessel off the Hawaiian coast. The next year, the McKinley Tariff removed the trade advantage of Hawaii sugar producers, who relied overwhelmingly on American markets, by putting sugar on the duty-free list and granting a bounty to American sugar growers. The Hawaiian economy dropped into a depression, and as a result, white sugar growers favored establishment of an American protectorate or outright annexation. Their plans were thwarted when Queen Liliuokalani, supported by Hawaiian nationalists, ascended the throne in January 1891.</span><span>The February 1892 elections in Hawaii resulted in a virtual deadlock between three parties. Soon afterward, the new U.S. minister, John L. Stevens, requested instructions on how to react should rebels, who had consulted with him, overthrow the monarchy to establish a republic. In May, Lorrin Thurston, a Hawaiian legislator and member of the secret Annexation Club, arrived in Washington, D.C., to lobby the Harrison administration to support a republican revolution. He met with Secretary of State James Blaine and Navy Secretary Benjamin Tracy, but was not allowed to see the president. In his final annual message to Congress in December 1892, Harrison endorsed development of the Pearl Harbor naval base and the laying of a telegraph cable to Hawaii.</span><span>The Hawaiian cabinet resigned on January 12, 1893. Two days later, the queen announced a new constitution reasserting monarchical powers, and the Annexation Club moved to create a provisional government. On January 16, Stevens ordered the 165-man U.S.S. Boston to land, ostensibly to protect the American mission. The next day the rebels proclaimed a republic headed by Judge Stanford Dole, a wealthy planter. The strategic placement of the American troops proved instrumental in preventing the royal forces from effectively responding to the coup. On his own authority, Stevens recognized the new Hawaiian government, proclaimed it an American protectorate, and ordered the American flag flown on all government buildings. </span><span>Less than a month later, the new Hawaiian government had drafted and passed an annexation treaty, which it sent to the outgoing Harrison administration. After receiving assurances from U.S. ministers in France, Great Britain, and Russia that those nations would not protest, the Harrison administration signed the annexation treaty on February 14 and forwarded it to the Senate. Harrison warned that annexation would prevent Hawaii from falling under the control of another great power, which would threaten American interests and security. However, there was not enough support in the outgoing Republican-controlled Senate for the two-thirds vote required for ratification, and the incoming Democratic Senate would certainly defeat it. </span><span>On March 9, the new president, Democrat Grover Cleveland, withdrew the treaty and appointed a committee to investigate American involvement in the bloodless Hawaiian coup. The report, released on July 25, harshly criticized Stevens’s role in the rebellion, argued that most native Hawaiians did not favor annexation, and suggested that the annexationists were acting out of economic self-interest. The Cleveland administration requested that Dole and the provisional government abdicate, and that the queen grant them amnesty and recognize their acts while in office. Both sides resisted, and in his December 1893 message to Congress, Cleveland handed the dilemma to them. After extensive hearings, and the rejection of various proposals, Congress decided to leave the situation as it existed with the minority government in power and Hawaii independent.</span><span>In March 1897, William McKinley, the new Republican president, met with his advisors to discuss whether it was preferable to annex Hawaii by treaty or congressional resolution. In April, the Hawaiian minister to the U.S. officially requested that the McKinley administration begin negotiations on an annexation treaty. Around the same time, the Republican-controlled Senate was preparing to prohibit Hawaiian sugar from the American market. On June 16, President McKinley sent an annexation treaty to the Senate, stating that the annexation of Hawaii by the United States was only a matter of time. Although most Republicans supported the treaty, Southern Democrats looked upon it with disfavor for reasons of economics (sugar interests</span><span>Robert C. Kennedy</span></span>
