HMO Reporting, Bulletins and Legislative Reports

Much of the regulatory activity Managed Care Systems conducts is public information. In addition, the section releases administrative bulletins for health plans if there are changes in coverage requirements, and legislative reports at the direction of the legislature.

Health Plan Reports and Results

Listed below are four areas of public information submitted by HMOs and CBPs as required to maintain licensure. For more information or to view these documents click on the links below.

1.  Financial Reporting - HMOs and CBPs also need to show evidence of financial solvency and are required to submit annual and quarterly financial statements, annual reports of revenues and expenses, and annual reports of enrollment. A financial examination by the Department of Commerce is conducted at least every five years.

• Financial examinations are available on Commerce Actions and Regulatory Documents Search (CARDS). Select “Insurance Financial Examinations” under Area of Interest, then select the health plan under Company. 
• Annual Reports of Revenue and Expenses
  • Statement of Revenue, Expenses and Net Income
  • Reallocation of Expenses and Investment Income

2.  Quality Assurance- Aside from investigating individual complaints, the Department of Health conducts Quality Assurance Examinations at least every three years. In addition, aach HMO and CBP compiles statistics on quality, access and other performance markers as determined by the NCQA. These statistics, part of the Healthcare Effectiveness Data and Information Set (HEDIS) are compiled in the same manner by each plan and allows consistent comparison between plans or to measure improvements from year to year. See HMO Quality Audits and HEDIS Measures.

3.  Enrollment - Each HMO and CBP submits enrollment information on a yearly basis. These reports also break down the enrollment populations by product and age.

Administrative Bulletins

Joint Administrative Bulletin 2023-1 November 1, 2023: Gender Affirming Care Bulletin (PDF)

Administrative Bulletin March 1, 2022 re: Conversion Therapy (PDF)

Legislative Reports

HMO Conversion Study

The 2023 Legislature passed a bill HF 402 that directed MDH to complete a study and make recommendations on the conversion of Minnesota-based nonprofit Health Maintenance Organizations to for-profit status. MDH to produced two reports that cover a range of issues including recommended oversight for conversions (which agency or entity, role of public input into the process, stewardship of public benefit assets), regulation of for-profit HMO’s post-conversion, and the regulatory structure needed to manage any potential return of public benefit assets to the state general fund if a nonprofit HMO or health system converts to for-profit or is purchased by an out-of-state or for-profit entity.

Study of HMO Conversions - Final Report to the MN Legislature, 2024 (PDF)

Study of HMO Conversion - Preliminary Report to the MN Legislature, 2024 (PDF)

Drug Prior Authorization Compliance

Drug Prior Authorization Compliance Report to the Minnesota Legislature 2021 (PDF)

For more information, email health.mcs@state.mn.us.