In the Central and Western regions, referrals are not required for in-network mental health and substance abuse services. In the Eastern region, referrals are required after a member self-refers for four visits annually. Capitation Rates State will not disclose capitation rates. Rate Setting Rates are adjusted for eligibility category, age, sex and geography. Mental health services are included in the capitation rate except for children in state custody.
State provides supplemental payment for deliveries.
In the Central region only, MCOs can elect to receive reduced capitation rates in exchange for state-sponsored reinsurance coverage. In 1998, there were 879 individuals enrolled in the program. Individuals who have insurance may be eligible if their insurance premiums are 300 percent of standard rates. There is a 12 month waiting period for pre-existing conditions, but the waiting period may be waived if already met under prior coverage and was involuntarily terminated, and if applied for within 60 days or if rates are 300 percent of standard rates set by pool. Communicating for Agriculture.