Hennepin Health

Hennepin Health is a plan that offers medical, behavioral health and social services for Hennepin County residents ages 21 through 64 who are without children and eligible for Medical Assistance (Medicaid). 

Hennepin Health is provided in partnership with NorthPoint Health and Wellness Center, the Hennepin County Human Services and Public Health Department, and Hennepin County Medical Center.

Eligibility requirements

To be eligible for enrollment, you must:

  • Be a resident of Hennepin County
  • Be between the ages of 21 and 64
  • Not have any dependent children
  • Be eligible for Medical Assistance (Medicaid)

 

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Patient protection

Transition to Metropolitan Health Plan

The Patient Protection Act of the State of Minnesota gives you the right to know how Metropolitan Health Plan (MHP) will handle your transition to MHP.

Members with special medical needs can get an out-of-plan referral to continue care at their current clinic. Some of these special needs include:

  • Members who require ongoing medical attention, such as cancer therapy, mental health or chemical health therapy, or women in their third trimester of pregnancy
  • Members with cultural or language barriers

Members must send a written statement to MHP asking approval to continue care at their current clinic. Requests are reviewed on a case-by-case basis.

If you have any questions regarding the above information, please call Member Services.

To access 24-hour information about the Medicare Plan Transition process please check the Medicare Prescription Drug Plan Finder (external link).

Upon request, this information will be made available in an alternative format, such as Braille, large print, or audiotape.

Provider Reimbursement

The Patient Protection Act of the State of Minnesota gives you the right to know about how your doctor or clinic is paid for the services that they provide to you as a Metropolitan Health Plan (MHP) member.

Who we contract with

MHP has contracts with such providers as medical clinics, hospitals, doctors, and other health care professionals to provide health services for MHP members. A number of things determine the rate of payment and payment methods. These include the type and amount of services provided and the number of MHP members using the services.

Incentives

It is important for you to know that the only incentives MHP offers to providers are incentives to improve the health of its members. For example, MHP may offer a clinic an incentive to increase immunizations or health screenings. MHP may also offer incentives to improve the number of child and teen health checkups or prenatal visits provided to our members.

How providers are paid

You have the right to know the method MHP uses to pay your health care provider. If you ask your provider, your provider has to tell you. Your providers will not talk about the amount MHP has agreed to pay them.

Payment Methods
The different ways MHP might pay a provider.

Provider Payment Methods

MHP uses the following payment methods to pay providers:

Fee Screen

MHP pays the provider based upon a fee screen. A fee screen is a list of procedures and services to be paid at a fixed price.

The fee screen is usually determined by averaging the prices charged by all of the providers within a community or region. As providers increase prices for specific procedures and services, fee screen prices increase. (This is also the method most often used by MHP to pay providers who do not have a contract but have been authorized to serve MHP members.)

Discounted Fee for Service

MHP pays the provider a percentage of what the provider usually charges for a specific procedure or service. MHP and the provider agree on the amount of the discount in advance.

Capitation

MHP pays the doctor or clinic a fixed amount each month, based on the number of MHP members choosing the doctor or clinic as a primary care provider.

MHP pays larger dollar amounts to doctors and clinics that agree to be responsible for all or most of their patients’ health care needs. For example, a medical clinic that agrees to coordinate and/or pay for hospital, home health, and specialty care receives a higher monthly payment than a clinic that agrees to provide only those services available at the clinic.

Note: If the provider’s payment exceeds the provider’s cost, the provider keeps the excess. If the cost of providing the member's care exceeds the provider’s payment, the provider generally is responsible for the extra cost.

Per Stay Hospital Rates

MHP pays some hospitals a fixed dollar amount for hospital stays, based on the reason the member is there, not the length of the stay. If the member stays in the hospital for a time longer than expected or requires more covered services than expected, MHP may pay the hospital more.

Per Day Hospital Rates

MHP pays some hospitals and treatment programs a fixed price for each day the member stays in the hospital or treatment. This price includes all of the covered services provided during the stay.

Access to Specialty Care

This information is provided in accordance with the Minnesota Patient Protection Act.

When you need to get approval before you can get a service

Certain health services provided under the direction of your physician require prior Metropolitan Health Plan (MHP) approval.

These services include:

  • Home health care,including registered nurse services, home health aide services, physical therapy, laboratory services, oxygen, durable medical equipment, and related supplies
  • Chiropractic services
  • Private duty nursing provided by a registered or licensed practical nurse regardless of location
  • Accident-related dental services when services are required for treatment of accident-related injury to sound natural teeth
  • Prosthetic and orthotic supplies, including braces and artificial limbs and eyes, made necessary as a result of injury or sickness occurring while coverage under this contract is in force
  • Treatment of temporomandibular joint (TMJ) disorders, except a single preliminary exam, including diagnostic tests, evaluations, non-surgical treatments, and surgical treatment
  • Durable medical equipment

Standing Referrals

The Patient Protection Act of the State of Minnesota gives you the right to know that you may request a standing referral to a specialist.

What it is

A standing referral is a written consent to be seen by a specialist for a chronic condition. This makes it easier for patients to see specialists on a regular basis without having to get permission each time.

What referrals and standing referrals are for

Services that are not provided by your primary clinic must have a written referral by a physician. A referral is written approval to go to the specialty clinic that comes from the primary clinic. The referral must be written before you can be seen at the specialty clinic.

Members can ask for a standing referral to a specialist for medical treatment. The standing referral must be in writing from your primary clinic and state all services to be provided and for how long. The specialist is not able to make additional referrals for services without permission from your primary clinic.

Contact

If you have any questions regarding the above information, please call Member Services at 1-888-562-8000 from 8 a.m. to 8 p.m., seven days a week.

Upon request, this information will be made available in an alternative format, such as Braille, large print, or audiotape.

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Edited: 12/04/2013 by CMS submitted pending approval

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