HMO - Medica Health Plans

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.

MDH goals were to have complaint category reporting by HMOs to be;

  • As least burdensome as possible yet meet the statutory requirements;
  • Consistent with Statutory language;
  • Comparable to grievance reporting done to DHS for MHCP;
  • Easily mapped to NCQA categories.

To that end, the following are the required complaint category reporting;

  • Complaint categories with definitions;
  • Complaint outcomes;
  • Quality of Care Severity levels;
  • HMO Complaint Reporting Requirements.

HMO Complaint Category Reporting (PDF)

A template for HMOs to use for reporting the Complaint Category data to MDH can be found here HMO Complaint Category Reporting (Excel).



Quality of Care Complaints Subject to Peer Protection Confidentiality

Pursuant to Minnesota Statutes §62D.115, subd. 2(h), MDH issued a Request for Information to gather input from interested stakeholders in defining complaints that are subject to peer protection confidentiality. In addition to input from stakeholders MDH considered Minnesota state law and federal law.*

Definition

Complaints subject to peer protection confidentiality are complaints, from any complaint category, that result in any patient harm or have the potential for patient harm that are related to the care and treatment of patients by a provider as defined under Minnesota Statutes 62M.02, Subd. 17.

HMOs should begin using this definition of peer protection confidentiality as they receive and investigate quality of care complaints. If you have questions, please contact Managed Care Systems at health.mcs@state.mn.us or 651-201-5176

*Resources

Minnesota Statutes, Section 145.61-67

Minnesota Statutes, Section 62D.115

Health Care Quality Improvement Act (HCQIA) of 1986.


For more information, email Tricia Hearth.

Updated Friday, January 19, 2018 at 01:23PM