Overview
Minnesota’s active legislative efforts aimed to increase healthcare price transparency and cost containment demonstrate the state’s commitment to improve its health care system. A leader in price transparency, the state has an active All-Payer Claims Database (APCD), which has been expanded to study cost, quality, and utilization. The state mandates that the Minnesota Hospital Association provide a hospital-specific performance and charge database for the 50 most common inpatient diagnosis-related groups. Minnesota also earns top grades for protecting patients from surprise and balance billing. In both emergency and non-emergency situations, a network provider is prohibited from billing an enrollee for any amount in excess of the allowable amount the health carrier has contracted for with the provider as total payment for the health care service. In recent terms, the state has introduced legislation that would require health plan companies to develop and implement a right to shop/shared savings incentive program.
In addition to promoting price transparency, Minnesota regulates anticompetitive practices in insurer and provider contracts in several ways. To encourage greater price transparency, the Patient Protection Act prohibits gag clauses in insurer-provider contracts and requires providers to give consumers a “good faith estimate” of the cost of common medical procedures within 10 days of request. Minnesota is also one of the few states that bans most favored nation clauses in provider contracts as well as exclusive contracting practices between health care network cooperative and healthcare providers.
Minnesota has promoted the use of telehealth well before its popularity brought on by the coronavirus pandemic. The Minnesota Telemedicine Act, enacted in 2015, provides parity between telemedicine and in-person services and requires health carriers to reimburse telehealth services on the same basis and at the same rate as the health carrier would apply to those services if the services had been delivered in person.
To help constituents deal with skyrocketing insurance costs, the Minnesota Legislature passed a bill in 2017 that allocated $271 million to form a publicly funded reinsurance pool that would help health insurance companies pay the most expensive medical claims, thereby lowering overall insurance premiums. In Minnesota’s reinsurance program, health insurers are eligible for reimbursements from the state for claims between $50,000 and $250,000. The insurers are responsible for amounts over $250,000. The reinsurance pool has performed exceptionally well and has decreased premiums by 15% in the first year. The state also continues to introduce state market initiatives including proposals to implement a public option via MinnesotaCare Buy-In, as well as proposed studies to analyze the cost and benefit of a potential universal health care system compared to the current healthcare financing system.
See below for an overview of existing Minnesota state mandates. Click on citation tab for detailed information of specific statutes (click link to download statute text).
State Action
Latest Legislative Session: 1/3/2023 - 5/22/2023 (2023-2024 term). *Current session bill updates are ongoing. Check back weekly for updates.
HF 1 (see companion bill SF 1) – Minnesota
Introduced: 2017 Status: Enacted
HEALTH INSURANCE PREMIUM RELIEF: Provides 25 percent discounts to Minnesotans who buy their health insurance on the individual marketplace and earn too much money to qualify for existing federal subsidies. The package includes $15 million to …
HF 1002 (see companion bill SF 487) – Minnesota
Introduced: 2021 Status: Inactive / Dead
Affordable Care Act provisions codified, guaranteed issue required of individual health plans offered by health plan companies to Minnesota residents, and unfair discriminatory practices prohibited.
HF 1016 (see companion bill SF 552) – Minnesota
Introduced: 2021 Status: Inactive / Dead
Nurse licensed by a border state exempted from obtaining a Minnesota license when providing aftercare.
HF 1030 (see companion bill SF 1264) – Minnesota
Introduced: 2023 Status: In Process
This bill eliminates enrollee cost-sharing under MA, MinnesotaCare, and SEGIP plans effective January 1, 2024, and eliminates cost-sharing for private market individual and small group insurance plans, effective upon federal approval of an amendment to …
HF 1031 – Minnesota
Introduced: 2021 Status: Inactive / Dead
A bill to establish a prescription drug affordability board and related regulations; modifying various provisions governing insurance. The commissioner of commerce shall establish the Prescription Drug Affordability Board, which shall be governed as a board …
Minn. Stat. § 256B.0757. Coordinated care through a health home: Medical Assistance for Needy Persons – Minnesota
Introduced: Status: Enacted
The commissioner shall provide medical assistance coverage of health home services for eligible individuals with chronic conditions who select a designated provider as the individual’s health home.
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Minn. Stat. § 256B.0758. Health care delivery pilot program: Medical Assistance for Needy Persons – Minnesota
Introduced: Status: Enacted
The commissioner may establish a health care delivery pilot program to test alternative and innovative integrated health care delivery networks, including accountable care organizations or a community-based collaborative care network created by or including North …
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Minn. Stat. § 256B.0915. Medicaid waiver for elderly services: Medical Assistance for Needy Persons – Minnesota
Introduced: Status: Enacted
The commissioner is authorized to apply for a home and community-based services waiver for the elderly, authorized under section 1915(c) of the Social Security Act, in order to obtain federal financial participation to expand the …
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Minn. Stat. § 256B.0941. Psychiatric residential treatment facility for persons younger than 21 years of age: Medical Assistance for Needy Persons – Minnesota
Introduced: Status: Enacted
An individual who is eligible for mental health treatment services in a psychiatric residential treatment facility must meet certain criteria.
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Minn. Stat. § 256B.0943. Children’s therapeutic services and supports: Medical Assistance for Needy Persons – Minnesota
Introduced: Status: Enacted
Subject to federal approval, medical assistance covers medically necessary children’s therapeutic services and supports as defined in this section that an eligible provider entity certified under subdivision 4 provides to a client eligible under subdivision …
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United States and State of Minnesota and State of New York v. UnitedHealth Group and Change Healthcare – Minnesota, New York
District Court: District of Columbia Status: Decided
The DOJ, along with attorneys general of New York and Minnesota, filed a lawsuit in federal court in the District of Columbia to block UnitedHealth …
Minnesota v. Sanofi-Aventis U.S. LLC – Minnesota
District Court: District Court of New Jersey Status: Pending
Minnesota’s attorney general filed a suit accusing Sanofi, Eli Lilly, and Novo Nordisk, the three largest manufacturers of insulin, of price gouging. The lawsuit, filed in …
In the Matter of CentraCare Health System, a corporation – Minnesota
District Court: United States of America Before The Federal Trade Commission Status: Decided
On January 9, 2017, the FTC approved a final order settling charges that CentraCare’s acquisition of St. Cloud Medical Group, would be anticompetitive. The consent order …
In re: Suboxone Antitrust Litigation (State of Wisconsin, et al. v. Indivior Inc, et al.) – Alabama, Alaska, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New Hampshire, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, South Dakota, Tennessee, Utah, Virginia, Washington, West Virginia, Wisconsin
District Court: E.D. Pennsylvania Status: Pending
In September 2016, 35 state attorneys general and the District of Columbia brought a multi-district case against pharmaceutical manufacturer Indivior, MonoSol RX et al., alleging …
In Re: Generic Pharmaceuticals Pricing Antitrust Litigation – Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin
District Court: Eastern District of Pennsylvania Status: Pending
Plaintiffs are attorney generals from 48 states, Puerto Rico, and the District of Columbia, as well as classes of private plaintiffs that filed an antitrust …
Additional Resources
STATE BUDGET
The Minnesota state budget operates on a biennium cycle, covering two fiscal years. Minnesota’s fiscal year begins on July 1 and ends on June 30 of the following year. To view Minnesota’s latest enacted budget, click here.
REGULATION & ENFORCEMENT
- On June 29, 2015 the Federal Trade Commission (FTC) responded to a request from two Minnesota state legislators to analyze the competitive impact of recent amendments to the Minnesota Government Data Practices Act (MGDPA). The amendments may require health plans contracting with the state to make information normally deemed competitively sensitive available to the public. The FTC expressed concern that this change would harm consumers by increasing the potential for collusion and decreasing the use of selective contracting. Read the FTC’s Press Release and Blog Post.
KEY RESOURCES
- Minnesota State Legislature
- Minnesota Office of the Attorney General
- Minnesota All Payer Claims Database
- Minnesota Department of Commerce