This is an archived document and does not contain the most current information for this topic. Use this document for reference only.
Program IM
2.5.4.4.2 Health Care Delivery (Archive)
Program IM enrollees must follow guidelines for receiving medically necessary services.
Fee for Service
People already residing in an Institution for Mental Diseases (IMD) at the time of initial enrollment are excluded from managed care and medical services are provided via fee for service.
Fee-for-service is a method of payment where the medical provider bills MHCP for specific, individual services. Enrollees must use a medical provider enrolled with MHCP, except in special circumstances. A directory of enrolled providers is available online.
Managed Care
People who are already enrolled in an MA managed care health plan when they enter an IMD will remain enrolled if they were placed in an IMD by the managed care plan, or for whom the plan was court-ordered to pay for treatment in the IMD.
Most MHCP enrollees receive services from a managed care health plan or network of providers. The health plan coordinates the services provided. The Minnesota Department of Human Services (DHS) pays a fixed rate in advance for each enrollee.
Detailed information on managed care and managed care exemptions is in the Prepaid Minnesota Health Care Programs (PMHCP) Manual.
Covered Services
The MHCP Summary of Coverage, Cost Sharing and Limits (DHS-3860) explains covered services and cost-sharing requirements. People who reside or expect to reside for 30 days or more in a medical institution (including IMDs that are psychiatric hospitals and Rule 36 residential treatment programs) are exempt from co-payments.
Legal Citations
Minnesota Rules, parts 9500.1450 to 9500.1464
Minnesota Rules, part 9505.0285