What are MCO's?
DHS contracts with managed care organizations (MCOs) and counties or groups of counties, also known as County Based Purchasing or CBP, to provide health care services for people on Minnesota Health Care Programs (MHCP). There is more information on MCO funding and fee-for-service options in Module 5. Most Elderly Waiver (EW) participants receive waiver services through MCOs.
MCO Reponsibilities
MCOs are responsible for details relating to service delivery. These details include:
- Service administration
- Determines its provider network
- Determines how services are delivered
- Determines which services require authorization, referral, etc.
- Determines its reimbursement rates to providers
- Pays only for medically necessary services, except in the case of home and community based services
