In “pre-paid managed care”, MH-TCM services are provided to eligible enrollees of the MCO by MH-TCM providers that the MCO contracts with, or who are authorized by the MCO.
MCO-contracted providers of MH-TCM are reimbursed at a monthly rate negotiated between the provider agency and the MCO. The monthly rate is paid if at least one case management core service component is provided consistent with the ICSP in at least one face-to-face contact with that client during that month. MCOs have option to reimburse with “tiered” monthly rates based on MH-TCM service intensity or client level of care needs. The MCO determines if telephone contact with the client will be reimbursed.
The provider bills and is reimbursed by the MCO. DHS pays the MCO a capitation to manage health care services, including MH-TCM, for the enrollees of the MCO.