Provider Cooperative Contract Review

The 2009 Minnesota Legislature passed a law establishing a review, approval, and monitoring process for contract, business or financial arrangements of health provider cooperatives  (Minnesota Statutes Section 62R.09). Under this process, a health provider cooperative must submit an application for any modifications, renewals, or extensions of all contract, business or financial arrangements to the Minnesota Department of Health (MDH). MDH is required to review the application and issue a finding based on the impact of the proposed arrangement on the health care marketplace and to actively monitor the arrangement.

In conducting its review, the MDH is required to consider certain issues, including:

  • Whether the arrangement is likely to produce significant efficiencies that benefit consumers, such as cost savings or improvements in quality of or access to care;
  • If the arrangement is likely to have any anticompetitive effects on the marketplace; and
  • Provided that the potential anticompetitive effects outweigh the pro-competitive efficiencies resulting from the arrangement.

Under the statute, MDH may request additional information 30 days after receiving an application and must approve or deny an application within 60 days after receiving the application or 60 days after receiving additional information requested.

Application Guidance for Health Provider Cooperative Review Process (PDF: 91 KB/3 pgs)

Health Plan Data Request

In the course of conducting the contract reviews, MDH is requesting information from health plan companies to assist in evaluating the potential pro- or anticompetitive impact of the health care provider cooperatives on the local health care market pursuant to Minnesota Statutes,Section 62R.09 subdivision 1 (c). As part of this data request, MDH requires that health plan companies submit aggregated data as specified in the formset, instruction and notification letter.

Data submitted under this health plan request is considered non-public information.

2012 Formset and Instructions (Excel: 351 KB)

2012 Notification Letter (PDF: 58 KB/1 pg)

Health Provider Cooperative Reviews

*Note: All appendices not shown are trade secret.

Contract with America's PPO
Submission filed: January 12, 2012
Contract with CorVel Healthcare Corp.
Submission filed: December 27, 2011
Contract with HealthPartners
Submission filed: December 27, 2011
Contract with Humana
Submission filed: September 12, 2011
Contract with Medica
Submission filed: December 27, 2011
Contract with MultiPlan Inc.
Submission filed: October 29, 2012
Contract with PreferredOne
Submission filed: July 8, 2011
Contract with Prime West
Submission filed: December 27, 2011
Contract with Sanford Health Plan of MN
Submission filed: May 27, 2011
Contract with South Country Health Alliance
Submission filed: September 22, 2011
Contract with UCare
Submission filed: December 27, 2011

Public Comment

If you would like to make a comment on any provider cooperative review, please contact:

Stefan Gildemeister
MDH-Health Economics Program
P.O. Box 64882
St Paul, MN 55164-0882
Email: stefan.gildemeister@state.mn.us

 


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Updated Monday, August 26, 2013 at 12:02PM