Prepaid Minnesota Health Care Program
The term prepaid means that DHS has paid the MCO to be responsible for and manage the health benefits, including adult MH-TCM, of the MCO’s enrollees. The adult MH-TCM provider bills and is reimbursed by the MCO for the qualifying service; and the provider must follow MCO provider procedures.
DHS pays a Per-Member-Per-Month (PMPM) capitation for a health care benefits set, that the MCO manages for the enrollees. A small portion of the PMPM payment is for managing the MH-TCM benefit.
To serve an eligible adult who is an enrollee in a prepaid MHCP, an adult MH-TCM provider agency must be under contract with and/or be authorized by the enrollee’s MCO to provide adult MH-TCM to that enrollee.