Health Maintenance Organization (HMO) premiums are payments made to contractors or other entities for eligible Medicaid recipients for:

1)       Prior authorization of high resolution imaging procedures (Med Solutions),

2)       Behavioral health services in a five-county area (Piedmont Cardinal Health Plan), and

3)       Program for All Inclusive Care for the Elderly.

All requests for high resolution imaging procedures for Medicaid recipients must be prior approved, except for procedures in emergency rooms and inpatient hospital settings.  A per member per month payment is made to Med Solutions to manage this function. High resolution procedures include PET scans, MRIs, CAT scans and ultrasounds.

Piedmont Cardinal Health Plan is a managed behavioral health care program that authorizes and coordinates all the behavioral health services in the five county area of Cabarrus, Davidson, Rowan, Stanley and Union.  A per member per month payment is paid to Piedmont Behavioral for all the Medicaid recipients in these counties.  The services include all psychiatric inpatient care, outpatient services, CAP/MR/DD and ICF/MR services.

PACE is a national model for a capitated managed care program for the frail elderly. The PACE model is regulated by the Centers for Medicare and Medicaid and combines Medicaid and Medicare funding to serve persons who meet the nursing facility level of care. PACE offers a comprehensive array of services to those persons enrolled in the program. Additionally, the enrollees receive oversight and intervention from professional staff and frequent and detailed medical reviews. The overall goal is to manage all the health and medical needs of this

frail population in order to avoid hospitalization and long term care placement.