Program IM Health Care Delivery

Program IM enrollees must follow guidelines for receiving medically necessary services.

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

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.

People who are already enrolled in an MA managed care health plan when they enter an Institution for Mental Diseases (IMD) will remain enrolled in managed care.

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