DHS Program Resources Managed health care programs

Health Care

Prepaid Medical Assistance Program (PMAP) and County-based Purchasing (CBP)

PMAP

• DHS contracts with and makes capitated payments to health plans to deliver health care to eligible MA recipients.

• Health plans must provide all medically necessary MA covered services.

• DHS and the county mutually agree to an implementation time line.

• The county is actively involved in development of the PMAP request for proposal (RFP).

• The county reviews all health plan proposals submitted and makes recommendations to DHS. The county and DHS mutually select the health plans to serve the county.

• The county may develop contract language related to local public health goals.
  
• The county makes recommendations to DHS regarding health plan contract renewals.

• Dispute resolution processes for counties and health plans are available.

• Counties have an annual option to participate in county-based purchasing instead of PMAP.

CBP

• DHS contracts with and makes capitated payments to the county-based purchasing entity to deliver health care services to MA recipients who would otherwise be enrolled in PMAP.

• CBP entities must provide all medically necessary MA covered services.

• The CBP entity must meet Minnesota Department of Health statutory requirements for regulated health plans, but does not have to obtain a Certificate of Authority.

• The CBP entity may provide or purchase health care for recipients from individual providers, care systems or health plans.

• The CBP entity assumes all financial risk; risk may be assigned to a third party.

• Clients retain the same appeal rights as under PMAP.

• Dispute resolution process for counties is available.

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