Health Maintenance Organizations in Minnesota
In Minnesota, an HMO is either a non-profit corporation or a local government unit. An HMO provides comprehensive health maintenance services, or arranges for the provision of these services, to enrollees on the basis of a fixed prepaid sum without regard to the frequency or extent of services furnished to any particular enrollee.
Health Plan Information - County Based Purchasing
County Based Purchasing (CBP) is a health plan operated by a county or group of counties. The CBP entity purchases health care services for certain residents enrolled in Medical Assistance, General Assistance Medical Care, and MinnesotaCare. The participating counties are primarily rural.
Generally, counties propose arrangements that add value to public programs by:
- Assuring improved access to providers and community resources
- Improving coordination of health and human services
- Stabilizing and supporting existing community provider networks
CBP is authorized by Minnesota Statutes, section 256B.692, permitting counties to elect this purchasing system. CBP entities must meet the same requirements as HMOs or Community Integrated Service Networks (CISNs), as provided for under Minnesota Statutes, chapters 62D and 62N. Requirements are also set out in portions of Minnesota Statutes, chapters 62A, 62J, 62M, 62Q, and 72A.; and in Minn. Rules Part 4685.These requirements include standards for access, quality and financial solvency.
Implementing CBP Arrangements
CBP entities submit proposals and documentation to the Minnesota Department of Human Services (DHS) and the Minnesota Department of Health (MDH), the regulatory authority for HMOs. MDH reviews the proposals to assure that all consumer protections provided by law are reflected in the county-based purchasing arrangements. MDH makes a recommendation to DHS regarding the county-based purchasing proposal. DHS typically initiates competitive procurement and requests approval for a change in its agreement with the federal Centers for Medicaid and Medicare Services (CMS). Once operational, a county-based purchasing entity is subject to a contractual agreement with DHS and ongoing regulatory oversight by MDH.
Status of CBPs
Currently, three entities, representing 20 counties and over 26,000 enrollees, are
operational. These entities are:
- IM Care - Contact Info/ Report Summary
- South Country Health Alliance - Contact Info/ Report Summary
- PrimeWest - Contact Info/ Report Summary
For more information, or to file a complaint, contact MCS section at 651-201-5100 or 1-800-657-3916.