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Effective: December 1, 2006 |
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28.10ar1 - Service Delivery Systems (Archive) |
Archived: June 1, 2009 |
People with Minnesota Health Care Program (MHCP) coverage receive their health care services through either a fee-for-service or managed care delivery system. The system that will be used is determined by the person's program eligibility and county of residence.
Commonalities Between Systems.
Some of the differences between fee-for-service and managed care systems include:
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Fee-For-Service |
Managed Care |
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What providers are used? |
Any provider enrolled with Minnesota Health Care Programs. |
The health plan's doctors, clinics, hospitals, pharmacies, and specialists. |
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Is a referral needed to see a specialist? |
No. |
Yes; the primary health plan doctor will provide a referral. |
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Is the emergency room used for non-emergency care? |
Yes. |
The enrollee should call the health plan to be referred to the best place for care. |
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Are dentists available? |
Enrollees must locate an enrolled MHCP dentist. |
Enrollees see a health plan dentist in all but a handful of managed care counties. |
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Are all services (MA, GAMC, or MinnesotaCare) delivered through this system? |
Yes. All health care services for which an enrollee is eligible are delivered through the fee-for-service system. |
The health plan delivers most covered services; a few may be delivered through the fee-for-service system. |
In either type of delivery system:
l Enrollees must coordinate their coverage with any private health care coverage they may have.
l All enrollees receive a Minnesota Health Care Programs (MHCP) Membership Card. Health care providers use this card to verify eligibility.
l Enrollees with a history of using health care services improperly may be placed under the care of a specific provider who will coordinate their care.
For more information, see:
Fee-For-Service Delivery System.
Managed Care Delivery Systems.
Enrollees With Other Heath Care Coverage.
MHCP Membership Card.
Eligibility Verification System (EVS).