|
Effective: December 1, 2006 |
|
|
28ar1 - Health Care Service Delivery (Archive) |
Archived: June 1, 2009 |
People who are eligible for Minnesota Health Care Program coverage are eligible for various health care services, and receive those services through several different types of delivery systems.
To qualify for health care program coverage, enrollees must meet specific criteria for an eligibility group or basis of eligibility. These groups or bases help define the exact health care services that are covered, or the benefit set. In addition to the covered services, a benefit set may be further defined by other factors, such as co-payments, or limitations on some services.
People enrolled in Minnesota health care programs receive their health care services through a fee-for-service or a managed care delivery system. The type of delivery system may depend on a number of factors, such as the enrollee's eligibility group or basis of eligibility, living arrangement, or county of residence.
Most Minnesota Health Care Program enrollees receive health care services through a managed care delivery system. The primary resource for managed care policy and procedures is the Prepaid Minnesota Health Care Programs (PMHCP) Manual. However, a number of topics that most workers may need to be familiar with are included in this manual as well.
For further information, see: