This article is a section taken from Medical Assistance (MA) a part of the revisions and additions to the Minnesota Health Care Program Eligibility Policy Manual.
Program for People Living in Institutions for Mental Diseases (IMD) Health Care Delivery
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.
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.
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.
Minnesota Rules, parts 9500.1450 to 9500.1464
Minnesota Rules, part 9505.0285
CREDIT: The content of this post has been copied or adopted from the Minnesota Healthcare Programs Eligibility Policy Manual, originally published by the Minnesota Department of Human Services.
This is also part of a series of posts on Minnesota Healthcare Eligibility Policies.