County-Based Purchasing (Archive)

County-based purchasing (CBP) is an option that allows counties to choose to assume the responsibility for purchasing health care services for enrollees who are eligible for PMAP Prepaid Medical Assistance Program. The program through which MA managed care enrollees receive medical services./PGAMC (often referred to as just "PMAP"). County-based purchasing provides an opportunity for locally-designed service delivery systems that involve the coordinated efforts of counties, providers, and consumers.

DHS contracts with and makes capitation payments to the county-based purchasing entity, or managed care organization (MCO) An organization certified by the Minnesota Department of Health which agrees to provide all defined health care benefits to individuals in return for a capitated payment. MCOs are also referred to as "health plans.", to deliver health care services to MA and GAMC clients who would otherwise be enrolled in PMAP. The CBP entity may provide or purchase health care for enrollees from individual providers, care systems or health plans.

Counties have an annual option to participate in CBP instead of PMAP. A community planning process is required by statute. County-based purchasing requires approval from the Centers for Medicare and Medicaid Services (CMS) Administers the Medicare program and works in partnership with the States to administer Medicaid and other programs. Formerly known as HCFA..

To date, CMS has approved two county-based purchasing organizations:

l  South Country Health Alliance, which contracts with Brown, Dodge, Freeborn, Goodhue, Kanabec, Sibley, Steele, Wabasha, and Waseca counties.

l  PrimeWest Health System, which contracts with Big Stone, Douglas, Grant, McLeod, Meeker, Pipestone, Pope, Renville, Stevens, and Traverse counties.

Itasca Medical Care has met CBP licensing requirements with the Minnesota Department of Health. In Itasca County, the county administers the MCO, which is Itasca Medical Care. The county contracts with the providers for provision of services, and DHS pays the capitation rate directly to the county.

As in other managed care counties, county-based purchasing enrollees access services through the MCO. Each enrollee designates a primary care physician and dentist and other medical professionals when needed. Enrollees receive an identification card from the MCO in addition to their MHCP membership card.

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