Managed Care Regulation

Managed Care Regulation

The Managed Care Systems Section of the Minnesota Department of Health licenses and regulates Health Maintenance Organizations (HMOs), Community Integrated Service Networks (CISNs), County-Based Purchasers (CBPs), and Accountable Provider Networks (APNs). 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 ECP 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 Complaint Category Reporting

Pursuant to MS §62D.08 and §62D.115, MDH solicited input via an RFI from all interested stakeholders in May and again in July 2017 to ensure a broad base of responses. HMOs will begin collecting data for complaint category reporting to MDH in January 2018 for reporting to be included in the HMO annual reports due in April 2019.

Frequently Asked Questions and Hot Issues:

To find out more information about the health care provider networks and the service areas for health plans offered on MNsure in 2017, see 2017 MNsure Provider Networks and Service Areas.

For more information, or to file a complaint, contact MCS section at (651) 201-5100 or 1-800-657-3916.

Updated Thursday, November 02, 2017 at 08:45AM