Managed Care Regulation
The Managed Care Systems Section has licensing and regulatory oversight on all Health Maintenance Organizations (HMOs) and County-Based Purchasers (CBPs). Regulation helps to ensure that your health plan company follows all applicable laws and rules governing financial solvency, quality of care, access to services, complaints, appeals and other consumer rights.
The Managed Care Section also reviews Networks, Service Area and Essential Community Provider requirements for MNSure. We also provide information that may assist you in making decisions about your health insurance and your rights as a health plan company member. Click on the links below to view frequently asked questions, information, pamphlets and brochures that may be of interest.
HMO Conversion Study Final report is published.
Joint Administrative Bulletin 2023-1 November 1, 2023: Gender Affirming Care Bulletin (PDF)
New Enrollee Protections: The No Surprises Act
Administrative Bulletin March 1, 2022 re: Conversion Therapy (PDF)
Legislative Report July 14, 2021 re: Drug Prior Authorization Compliance (PDF)
Arbitration
- Unauthorized Provider Services Arbitration
Complaints
- MDH HMO Enrollee Complaint and External Review Process
Essential Community Providers
- Essential Community Providers
Reporting
- HMO Annual Reporting
- Enrollment Reports
Health Plan Info
- Health Plan Information - Minnesota Plan Listings
- HEDIS Reports
- Enrollment Reports
HMO Licensure
- Health Maintenance Organization Licensure
Mental Health Parity
- Mental Health and Substance Use Disorder Parity: Know Your Benefits
Provider Network Adequacy
- Provider Network Adequacy
Network Waivers
- Provider Network Waivers and Service Area Maps
Quality, Financial and Enrollment Stats
- Health Plan Reports and Results
FAQs
- Managed Care Frequently Asked Questions
Contact
- How to Contact the Managed Care Section