Checking in on Minnesota managed care


In 2012, the Minnesota Legislature passed legislation that would – for the first time – require independent, third-party audits of Minnesota’s public health care programs. Such programs are paid for by state and federal dollars disbursed through the Department of Human Services (DHS), and are administered by private, non-profit health maintenance organizations (HMOs). 

Managed care background

Minnesota HMOs receive blocks of funding from DHS to manage the care of public program enrollees, and they make payments to doctors and hospitals for the services rendered.  Until the 1990s, the state of Minnesota largely handled such provider payments directly, rather than through managed care intermediaries like HMOs.

Beginning in 2010, concerns emerged regarding the financial management of Minnesota’s public health care programs, including the degree to which HMOs were retaining state and federal monies earmarked for public program use.  To shed light on such questions, the Minnesota Legislature instituted biannual audits of public program spending, and tasked the Office of the Legislative Auditor (OLA) with retaining a third-party firm to conduct such audits.  2014 was the first program year scheduled to be reviewed.

Request for OLA records on audit firm search

On April 22nd, Public Record Media (PRM) submitted a public records request to OLA to seek documentation regarding OLA’s search for an audit firm, including requests for proposals, bids, and any signed contracts.  As 2014 is the inaugural year for the program audit, PRM is seeking information as to which firms have made bids to handle the auditing work.

PRM seeks records relating to 2012 managed care RFP

PRM also recently sought records relating to a request for proposals issued by DHS regarding the value of managed care programs.  The RFP, issued in October of 2012, sought a qualified vendor to “evaluate the value of managed care for state public health care programs.”

For many years, Minnesota HMOs have been required by law to administer public health care programs in order to handle other, commercial business.  The DHS RFP sought an evaluation of the value of this managed care approach relative to the direct payment “fee for service” model that it replaced.  The RFP also sought an evaluation of whether the statutory requirement for HMOs to handle public program business was still warranted or beneficial.

PRM will post responsive documents upon receipt.

Disclosure – Matt Ehling, president of PRM, also serves on the board of the Minnesota Coalition on Government Information (MNCOGI), which advocates for public access to Minnesota government data.  In that capacity, Ehling recently testified in a legislative hearing in favor of a bill that would clarify Minnesota law to ensure that all private government contractors (including HMOs) were covered by Minnesota’s open records statute.