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Better Health Care, Lower Costs

On October 31st, 2011, Governor Mark Dayton signed executive order 11-30, establishing a Vision for Health Care Reform in Minnesota.  The order charges the Minnesota Health Care Reform Task Force, along with members of the Governor's Cabinet, to develop an action plan for reforming how we deliver and pay for health care in Minnesota.

Governor Dayton has appointed leaders from business, labor, foundations, the public sector, and Minnesota's health care organizations to the Health Care Reform Task Force.  A list of task force members is available here.

The Minnesota Health Care Reform Task Force is charged by Governor Dayton to develop strategies that:

•  Improve access to health care for all Minnesotans

•  Lower health care costs by reforming how we pay for health care and changing the incentives, so we encourage preventative care and reward healthy outcomes, not sickness.

•  Improve the health of all Minnesotans and address the huge health disparities that plague our state.

On December 13th, 2012, the Minnesota Health Care Reform Task Force voted to endorse the Roadmap to a Healthier Minnesota , including its recommendations for how to increase access to high-quality car at lower cost. The report outlines eight strategies for policymakers to consider as they work to implement federal and state health reforms, including recommendations regarding increased access, care integration and payment reform, prevention and public health, and preparing the Minnesota health workforce of the future.  The Roadmap and Supplement are available at these links.

In addition, the Department of Commerce announced the formation of a Minnesota Health Insurance Exchange Advisory Task Force focused on establishing a Minnesota made Health Insurance Exchange. The members of that Task Force is available here.

The Minnesota Accountable Health Model

Minnesota has received a $45 million grant to provide better care at a lower cost from the Centers for Medicaid and Medicare Services (CMS) as part of the State Innovation Model Initiative.

Minnesota will use the funds to drive health care reform in the state and to test the Minnesota Accountable Health Model. The goal of this model is to ensure that every citizen of the state of Minnesota has the option to receive team-based, coordinated, patient-centered care that increases and facilitates access to medical care, behavioral health care, long term care, and other services.

The model will expand Minnesota's current Medicaid Accountable Care Organization demonstration and include 15 accountable communities for health. These communities will develop and test models for integrating care across the health care system.

By 2016, nearly 3 million Minnesotans are expected to receive care through the model. The model is projected to save $111 million over three years and lay the foundation for additional savings in years to come.

This is a joint project between the Minnesota Department of Health and the Minnesota Department of Human Services. The project will include advisory groups, such as the State Innovation Model Community Advisory Council.

Minnesota Accountable Health Model Summary (PDF 287K/4 pages)

CMS State Innovation Model Fact Sheet (PDF 314K/13 pages)

State Innovation Model Grant Application Materials (filed September 2012)
Executive Summary (PDF)
Abstract (PDF)
Letter from Governor Dayton (PDF)
Project Narrative (PDF)
Budget Narrative (PDF)
Innovation Plan and Appendices (PDF)
Letters of Support (PDF)

Meeting - November 2, 2012
Agenda (PDF)
The Minnesota Accountable Health Model Presentation (PDF)
SIM Grant Application Executive Summary (PDF)

Timeline of Health Reform

May 2008: Minnesota Health Care Reform Bill Signed Into Law

The law aims to improve the health care of Minnesotans, making services more accessible and affordable. It focuses on new approaches to primary care, reducing the burden of chronic disease, and establishing community standards for quality measures across the state.

August 2009: Minnesota Awards Statewide Health Improvement Program (SHIP) Grants

SHIP is a $47 million, two-year, community-level grant project aimed at reducing the burden of chronic disease associated with obesity and tobacco use.  The Minnesota Department of Health awards grants to all 87 counties and eight tribal governments. Focus areas include:
• Increase affordability and access to healthy foods in communities and schools.
• Create and enforce tobacco-free policies in post-secondary institutions and worksites
• Increase capacity for walking and biking – for transportation and recreation
• Implement comprehensive worksite wellness initiatives
• Work with providers to refer patients to community resources for the prevention of chronic disease.

January 2010 - December 2010: Rebates begin for Medicare Prescription Drug Coverage Gap

Minnesotans who have fallen into the Medicare Part D prescription drug coverage gap, also known as the “donut hole” receive a one-time, tax-fee $250 rebate check to help cover the cost of their prescriptions. 66,746 Minnesotans received the $250 rebate check in 2010.

March 23, 2010: Affordable Care Act Becomes Law

On March 23, 2010, the Patient Protection and Affordable Care Act became Law. Some of the pieces are in effect now, and others will go into effect through 2018.

March 2010: Minnesota Announces Health Care Home (HCH) Payment Rates

The Minnesota Department of Human Services announces its HCH care coordination rates – ranging from $10 to $60 per enrollee per month, depending on the complexity of the patient’s illness profile. Read more about the payment methodology.

June 2010: Coverage for People with Preexisting Conditions

Minnesotans who have been denied coverage and who have been uninsured for at least 6 months can qualify for a Preexisting Condition Insurance Plan.  This is in addition to Minnesota's own Minnesota Comprehensive Health Association Plan (MCHA).

June 21, 2010 - January 1, 2014: Early Retiree Coverage

A new fund for early retirees ages 55-65 will provide financial help for their employer-sponsored coverage plan to continue.

August 2010: Minnesota Announces First Certified Health Care Homes

The Minnesota Department of Health certifies the first 11 health care homes in the state, located in both urban and rural areas and ranging for single-physician to large systems clinics.

September 23, 2010: Young Adults Covered

If a young adult does not have health coverage from their employer, they can stay on their parents plan until they turn 26. Minnesota law requires some state-regulated health plans that offer dependant coverage to cover unmarried children up to age 25, regardless of whether the child works for an employer that offers health insurance.

September 23, 2010: Preventive Services

If you are enrolled in employer health coverage or a health insurance plan that was created after March 23, 2010, you can now receive certain preventive services at no cost to you. If you are covered by a Minnesota health plan, state law already requires coverage of many preventive services at no cost to you. Starting in 2014, all health insurance plans will be required to cover the full cost of preventive services.

September 23, 2010: No Lifetime Limits on Coverage

Insurance plans can no longer place a dollar limit on the health benefits they cover during your lifetime.

September 23, 2010: Annual Limits on Coverage Begin to Phase Out

Employer health insurance plans and individual plans issued after March 23, 2010 will gradually increase the dollar limits they place on how much care is covered in a year. In 2014, there will be no annual limits on coverage.


September 23, 2010: No Denials for Kids with Preexisting Conditions

Insurance plans can no longer deny coverage for children under 19 who have preexisting conditions.

September 23, 2010: Plans Cannot Revoke Coverage

Insurance plans cannot deny coverage, except in the case of fraud, because an application was filled out incorrectly or contains a technical error.

September 23, 2010: Appealing Insurance Decisions

Minnesotans can appeal coverage decisions or claims to their insurance provider and have access to an external review process.

October 2010: Community-based Services Through Medicaid

Minnesota expands access to community-based services to residents. Waivers for community based care programs are available for elderly, people with severe brain injuries, chronically ill people, disabled Minnesotans, and people with developmental disabilities. Minnesota also supports increased use of community-based programs through Medicaid.


November 2010: Minnesota Releases first Health Care Quality Report

The Minnesota Department of Health issues its first report on health care quality for diabetes care and vascular care based on 2009 data.

2010: Improving Access to Primary Care

New incentives expand the number of primary care doctors and nurses, and include financial incentives (i.e. loan forgiveness, funding for scholarships) primary care providers working in underserved areas.

January 2011: Minnesota Announces Health Care Homes Outcome Measures

The Minnesota Department of Health announces the quality measures that will be used to certify health care homes. Clinics and clinicians participating as certified health care homes begin submitting information on the quality of asthma and vascular care, health care costs, and patient experience.

January 2011: Discounts for Rxs in the Medicare Prescription Drug Coverage Gap

Minnesotans in the Medicare Part D prescription drug coverage gap, also known as the “donut hole,” receive a 50 percent discount on covered, brand-name prescription drugs and a 7 percent discount on generic prescription drugs. Savings on brand-name and generic drugs will continue over the next 10 years until the coverage gap is closed in 2020.

January 2011: Medicare Preventive Services

Minnesotans on Medicare receive certain preventive and screening services, such as mammograms and colonoscopies, at no cost to them. Those new to Medicare can receive a “Welcome to Medicare” exam within the first 12 months of enrolling.  All Medicare enrollees can receive an annual wellness visit with a health care professional 12 months after their “Welcome to Medicare” exam.

January 2011: Lowering Health Insurance Premiums

Insurers are required to spend 85 cents of every premium dollar received from large employer plans on health care services and health care quality improvements. They are required to spend 80 cents of every premium dollar received from individual plans and small employer plans on health care services and quality improvements.

January 2011: Center for Medicare and Medicaid Innovation

The new Center will work with states to deliver innovative care to patients to improve the quality of care and reduce costs for Medicare, Medicaid and the Children’s Health Insurance Program.

January 2011: Community Care Transitions Program

For Medicare enrollees who have been hospitalized, the new program will help coordinate care and connect patients with services to avoid unnecessary hospital readmissions.

January 2011 - December 2015: Medicare Bonus Payments to Health Care Professionals

Primary care physicians will receive a 10 percent bonus payment for office visits with Medicare enrollees. In addition, general surgeons practicing in underserved areas also receive a 10 percent bonus payment.

January 2011: Premium Increase for Higher-Income Medicare Part D Enrollees

Medicare Part D enrollees who earn more than $85,000 a year and couples who earn more than $170,000 a year will pay a higher premium for their Medicare Part D coverage.

January 2011: Changes to Flexible Spending Accounts (FSAs)

FSAs no longer reimburse for over-the-counter medicine that isn't prescribed by a health care professional.

March 1, 2011: Expansion of Medical Assistance

Minnesota adults with incomes up to 75% of the federal poverty level and without children are eligible for Medical Assistance.

March 23, 2011: Nutritional Labeling for Restaurants

Chain restaurants must include nutritional content for standard menu items. This change also applies to food sold in vending machines.

January 2012: Accountable Care Organizations (ACOs)

Health care professionals can join together to form an Accountable Care Organization through the Center for Medicare and Medicaid Innovation to help coordinate and improve patient care and reduce unnecessary hospital admissions. Health care professionals can share in cost savings if they meet certain quality standards.

March 23, 2012: Date Collection for Health Disparities

Current and new federal health programs are required to collect and report data on race, ethnicity, sex, primary language, disability status and underserved geographic populations to help understand and fight health disparities.

September, 2012: State Innovation Model Proposal

The Center for Medicare and Medicaid Innovation (the CMS Innovation Center) has made funding opportunities available to support states to transform their health care payment and delivery systems.  The following documents have been utilized in the statewide planning activities related to preparing Minnesota's proposal.

Summary of the August 7th meeting discussion
List of attendees from August 7th
Stratis Health Rural Accountable Care Community Logic model
Safety Net Coalition presentation
MN Association of County Health Plans presentation
CMMI Grant Application Charter (PDF)

October 2012: Electronic Health Records

Insurance plans must establish rules for secure and confidential electronic health records to help improve coordination and to reduce paperwork and administrative costs.

October 2012: Value Based Purchasing Program (VBP)

Financial incentives are offered to hospitals that improve the quality of care. Performance is required to be publicly reported on a number of measures, including surgical care, patient’s perception of care, and heart attacks.

2012: Medicare and Medicaid Home Based Care

Those enrolled in both Medicare and Medicaid who are receiving home and community based care have reduced Medicare Part D cost sharing that is equal to those enrollees who live in a skilled nursing facility or Intermediate Care Facilities.


January 2013 - December 2014: Primary Care Doctors Payments

Minnesota is required to pay primary care physicians performing Medicaid services no less than 100 percent of Medicare payment rates in 2013 and 2014, through the use of federal funds.

January 2013: Medicaid Preventive Health Coverage

New funding is available for state Medicaid programs to provide preventive services for Minnesotans at little or no cost.

April 2013: Financial Disclosure

Health groups, such as doctors, hospitals, pharmacists, manufacturers of medicine and medical devices, must disclose financial relationships with one another.

July 2013: Consumer Operated and Oriented Plan (CO-OP) Program

The Consumer Operated and Oriented Plan (CO-OP) Program will create nonprofit, member-run health coverage plans.

Fiscal Year 2013: (October 2012 - September 2013): Extension of CHIP

States will receive funding for two more years to continue covering children who are not eligible for Medicaid through the Children’s Health Insurance Program (CHIP).

January 2014: Individual Requirement to Have Health Insurance

Uninsured Minnesotans are required to purchase basic health insurance. Minnesotans who would spend more than 8 percent of their monthly income on health insurance are not required to purchase coverage.

January 2014: Health Insurance Exchange

An Exchange would allow uninsured residents, people with individual coverage and small businesses to compare and shop for affordable health insurance plans. Plans offered an Exchange would have to meet basic benefit and cost standards. Eligible Minnesotans and families could be enrolled in Medical Assistance and MinnesotaCare through an Exchange.

January 2014: Medicaid Expansion

Minnesotans who earn less than 133 percent of the FPL ($14,484 in 2011) will be eligible for Medicaid.


January 2014: Tax Credits and Cost-Sharing Subsidies

Minnesotans and families earning between 133 and 400 percent of the Federal Poverty Level (FPL) will be eligible for a tax credit to help pay for health coverage through an Exchange. Minnesotans and families who earn up to 250 percent of FPL—about $27,225 for an individual and $55,875 for a family of four in 2011—will also be eligible for cost-sharing subsidies on plans offered through the Exchange in 2014.

January 2014: No Annual Limits

Insurance companies can no longer place dollar limits on the amount of care that is covered in a year.

January 2014: No Denying Coverage for Preexisting Conditions

Insurance plans can no longer deny coverage or charge higher rates because of a preexisting condition.

January 2014: Employer Requirements

Large companies face a penalty if they do not offer health insurance to full-time employees or if their employees receive tax credits to purchase a plan in an Exchange because the employer plan is unaffordable.

January 2014: Wellness Programs

Companies can offer employees additional financial benefits for participating in wellness programs.

January 2014: Medicare Advantage Requirements

Instead of money being spent on administrative costs, Medicare Advantage plans are required to spend 85 cents of every dollar on health care for patients.

January 2014: No Health Condition Requirements

In Minnesota, health plans cannot require an applicant to complete a health questionnaire or deny them coverage because of their health condition.

January 2014: Under 30 Coverage Plans

Minnesotans under age 30 can purchase a comprehensive coverage plan or a catastrophic plan designed just for their age group.

January 2014: Hospital Care

Low-income, uninsured Minnesotans who need hospital care can be presumed eligible for Medicaid (Medical Assistance) if approved by hospital staff. Currently, hospital staff may only help who complete an application for coverage.

January 2014: Plans Must Accept All Applications

Health plans must accept every employer and every individual that applies for coverage, although they may create special enrollment periods.

January 2016: Insurance Across State Lines

Qualified health plans may be purchased across state lines through agreements between states.

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Health Insurance Exchange

To learn more about the Minnesota health insurance marketplace, visit MNsure

MNSure Website

Letters from State Agencies Responding to Requests for Comment

The Minnesota Departments of Commerce, Management and Budget, Human Services, and Health recently submitted letters to the Federal Government in response to several requests for comment: EHB and Actuarial Value (PDF); Multi-State Plan Program (PDF); Market Rules and Rate Review (PDF); and Notice of Benefit and Payment Parameters (PDF).

See current Requests for Comment