Managed Care Systems
For Consumers
- Enrollee External Appeals and Complaints
- Mental Health Parity
- The No Surprises Act
- Provider Network Adequacy
- HMO Quality Audits and HEDIS Measures
- FAQs
For HMOs, CBPs, and Providers
- Essential Community Providers
- HMO Licensure
- Health Plan Reporting Requirements
- Network Adequacy Filing Requirements
About Minnesota HMOs
Related Sites
Managed Care Systems
Regulating Health Maintenance Organizations, Provider Network Adequacy, and Consumer Services
The Managed Care Systems Section three primary functions:
- Regulatory oversight on all Health Maintenance Organizations (HMOs) and County-Based Purchasers (CBPs). Regulatory activities include:
- Licensing HMOs in Minnesota.
- Ensuring HMOs and CBPs are following state and federal laws.
- Ensuring HMOs and CBPs are providing quality care and are financially stable.
- Reviewing individual and small employer health plans to make sure they meet requirements under the Affordable Care Act.
- Provider Network Adequacy: This area focuses networks of health care providers that HMOs and health insurance companies have contracts with. Network Adequacy activities include:
- Reviewing health care provider networks for individual and small employer health insurance plans to determine if they meet statutory requirements.
- Designating Essential Community Proivders.
- Engaging stakeholders in modernizing and prioritizing network adequacy activities.
- Consumer Services: This area provides information on health insurance resources, and helps consumers resolve complaints, which includes:
- Helping consumers with HMO complaints.
- Helping consumers file external appeals from HMOs.
- Helping with No Surprises Act (balance billing) complaints.
- Providing information and consumer education on health insurance and resources for finding care through the Health Information Clearinghouse.
Updates:
NEW! Information on cost sharing for prescription drugs related to diabetes, asthma and certain allergies.
For HMOs, CBPs and Providers
- Essential Community Providers
- HMO Licensure
- Health Plan Reporting Requirements
- Network Adequacy Filing Requirements
- Quality Assurance Examinations – coming soon!
About Managed Care Systems
- HMO Reporting, Bulletins and Reports
- How to Contact the Managed Care Section
Last Updated: 05/07/2025