101.13 SERVICE DELIVERY SYSTEMS

The Division of Medicaid operates under two different payment models for services which are fee for service and coordinated care. Once an applicant is approved for Medicaid or CHIP, the individual is enrolled in one of these payment models based on their category of eligibility, age and whether enrollment is mandatory or optional for their category. 1. Fee for Service (FFS) – the recipient chooses his/her own provider of service that accepts Medicaid, and the provider is reimbursed by DOM. Fee for Service recipients are entitled to the full array of Mississippi Medicaid State Plan covered services. 2. Coordinated Care – this is a type of managed care whereby certain recipients are either required to enroll or may voluntarily enroll in a Coordinated Care Organization (CCO) and have their medical care managed by the CCO selected. CCO’s connect enrollees to a medical home and provide care management and disease management programs in an effort to provide cost-effective medical services. CCO’s are paid a capitation rate per enrollee and in turn, the CCO pays the medical claims to the Medicaid provider. CCO’s are required to cover all Mississippi Medicaid State Plan covered services unless the contract with the CCO’s states otherwise; however, CCO’s can also offer additional services not covered in the Mississippi State Plan, such as additional physician visits or additional pharmacy benefits. CHIP enrollees are required to select a CCO. Benefits covered are those required by the DOM CHIP Plan. For additional information on MSCAN and the mandatory and optional categories of eligibility that can or must enroll in a CCO, refer to the DOM website.