Managed Care Regulation

The Managed Care Systems Section has licensing and regulatory oversight on all Health Maintenance Organizations (HMOs) and County-Based Purchasers (CBPs). 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 Essential Community Provider 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.

New Enrollee Protections: The No Surprises Act

Administrative Bulletin re: Conversion Therapy (PDF)

Legislative Report re: Drug Prior Authorization Compliance (PDF)

• Arbitration

• Unauthorized Provider Services Arbitration

• Complaints

• MDH HMO Enrollee Complaint and External Review Process

• Essential Community Providers

• Essential Community Providers

• Reports

• HMO Annual Reporting
• Health Plan Reports and Results

• Health Plan Info

• Health Plan Information - Minnesota Plan Listings
• HEDIS Reports
• Enrollment Reports

• HMO Licensure

• Health Maintenance Organization Licensure

• Mental Health Parity

• Mental Health and Substance Use Disorder Parity: Know Your Benefits

• Provider Network Adequacy

• Provider Network Adequacy

• Network Waivers

• Provider Network Waivers and Service Area Maps

• Quality, Financial and Enrollment Stats

• Health Plan Reports and Results

• FAQs

• Managed Care Frequently Asked Questions

• Contact

• How to Contact the Managed Care Section