Health Services Advisory Council (HSAC)

• Bimaje Apka, MBBS – Physician Specialist
• Amy Burt, DO, FAAP, CHIE – Physician Representing a Health Care Plan
• Nathan Chomilo, MD, FAAP, FACP – Medical Director for Minnesota Health Care Programs (nonvoting member)
• Sagar Dugani, MD, MPH – Physician
• Tenbit Emiru, MD, PhD, MBA – Physician Representing a Health Care Plan
• Mame (Samba) Fall, Consumer
• Scott Hegstad, MD – Physician Representing a Health Care Plan
• Richard Printon, DC – Nonphysician Health Care Professional
• Saudade SammuelSon, Consumer
• Daniel Stein, MD, MPH – Physician
• Claudia Thomas, MD, FACP – Physician
• Michael Thorn, APRN, CNP, RN, MSN, MHA – Nonphysician Health Care Professional

Seats currently accepting positions:

• Physician Specialist
• Physician
• Physician representing a Health Care Plan

Appointing Authority: Commissioner of Human Services.
Compensation: $200 honorarium plus reimbursement for mileage and parking.
(Minnesota Statutes, 256B.0625, subdivision 3c)

• Jan. 10, 2024, 5:30-7:30 p.m.
  Jan. 10 agenda (PDF)
  Jan. 10, slide deck (PDF)
  Jan. 10 minutes (PDF)
• Feb. 14, 2024, 5:30-7:30 p.m.
  Feb. 14 agenda (PDF)
• March 13, 2024, 5:30-7:30 p.m. - Cancelled
• April 10, 2024, 5:30-7:30 p.m.
  April 10 agenda (PDF)
• May 15, 2024, 5:30-7:30 p.m.
• June 12, 2024, 5:30-7:30 p.m.
• July 10, 2024, 5:30-7:30 p.m.
• Aug. 14, 2024, 5:30-7:30 p.m.
• Sept. 11, 2024, 5:30-7:30 p.m.
• Oct. 9, 2024, 5:30-7:30 p.m.
• Nov. 13, 2024, 5:30-7:30 p.m.
• Dec. 11, 2024, 5:30-7:30 p.m.

• March 21, 2023, 5:30-7:30 p.m.
  March 21 agenda (PDF)
  March 21 presentation (PDF)
  March 21 minutes (PDF)
• April 19, 2023, 55:30-7:30 p.m.
  April 19 agenda (PDF)
  April 19 minutes (PDF)
• May 10, 2023, 5:30-7:30 p.m.
  May 10 agenda (PDF)
  May 10 minutes (PDF)
  May 10 AMENDED minutes (PDF)
• June 14, 2023, 5:30-7:30 p.m.
  June 14 agenda (PDF)
  June 14 minutes (PDF)
• July 12, 2023, 5:30-7:30 p.m.
  July 12 agenda (PDF)
  July 12 minutes (PDF)
• Aug. 9, 2023 - Cancelled
  
• Sept. 13, 2023, 5:30-7:30 p.m.
  Sept. 13 agenda (PDF)
  Sept. 13 minutes (PDF)
• Oct. 11, 2023, 5:30-7:30 p.m.
  Oct. 11 agenda (PDF)
  Oct. 11 presentation (PDF)
  Oct. 11 minutes (PDF)
• Nov. 8, 2023, 5:30-7:30 p.m.
  Nov. 8 agenda (PDF)
  Nov. 8 minutes (PDF)
• Dec. 13, 2023 - Cancelled
  

Meeting accommodation requests
To request a reasonable accommodation to make it possible for you to attend any of the meetings, please email hsac@state.mn.us at least two weeks before the meeting. Email hsac@state.mn.us if you have any questions.

Gender Affirming Care (PDF)

Those who want to speak during the public testimony portion of a council meeting must complete the HSAC Public Testimony Disclosure Form DHS-6201 (PDF). Please bring your completed form to the meeting. Blank forms also are available at all meetings.

The Health Services Advisory Council (HSAC) uses the following principles and procedures when selecting topic areas for its work and recommending policies. This document supplements HSAC’s Charter.

Principles

Scope of policy recommendations

• HSAC will consider recommending policies that affect coverage of services, measurement of quality, structures that enhance health, and design and implementation of health care delivery systems.
• Policy options include written and online pre-authorization, coverage policy communication and audit, data feedback of practice variation and quality measures, consideration of payment incentives, collaborative quality improvement efforts, selective contracting and shared patient decision-making.

Quality of care

• HSAC will address topics where issues about the quality or application of a service, process or device have been identified.
• Practice pattern variation is linked to quality of care. HSAC assumes that reducing variation in service use or outcomes unrelated to patient differences will help improve quality of care.

Population health

• HSAC will seek to identify topics that have significant health implications for persons served by Minnesota Health Care Programs (MHCP).
• Incremental improvements in widely received health care services that may have a greater positive effect on net population health status will be considered.
• HSAC will seek to identify topics that have significant potential for reducing disparities in access or health status among segments of MHCP populations.

Coordination with managed care

• HSAC should take reasonable steps to collaborate with DHS’ managed care partners in regard to specific policy development issues. HSAC seeks to work collaboratively with DHS managed care partners to share relevant information and data, including managed care policies and utilization information.
• HSAC may be used as a venue for identifying possible coverage policy variation or inconsistency.
• HSAC will avoid redundant policy development efforts.

Processes

Topic selection criteria

HSAC members will periodically consider lists of potential topics and rank and recommend a subset of these for inclusion as topics for the HSAC agenda. HSAC will use the following criteria when selecting and prioritizing topics for its work. Order of criteria does not imply priority:

• Magnitude of potential impact for improving the health of persons served by MHCP;
• Potential for improving the stewardship of MHCP resources;
• Potential for reducing health disparities among subpopulations served by MHCP;
• Extent of or potential for practice pattern variation unrelated to differences in patient populations;
• Likelihood of coverage variation or inconsistency within DHS or among managed care plans and DHS;
• Sufficiency and quality of evidence; and
• Whether other groups, internal or external to DHS, have addressed the topic or are in the process of doing so and whether HSAC’s contributions would add value or redundancy.

Sources of input

HSAC will consider input from the following sources when evaluating potential topics for discussion. Order of sources does not imply priority:

• HSAC will seek systematic input about potential policy topics from internal DHS sources; active solicitation of ideas from management and staff of benefit policy areas will be pursued.
• HSAC will actively seek HSAC members’ insight concerning selection of potential policy topics.
• HSAC will accept input on policy topic selection from all stakeholders, including providers, managed care partners, MHCP members and the general public.
• Utilization data, both from DHS and from its managed care partners, will be used when practical to inform HSAC about the scope, magnitude and trajectory of a given potential topic.
• National data and research about quality and utilization may be used to identify topics and inform discussion.

The DHS Commissioner will have final discretion concerning the selection of topics for HSAC.

The Minnesota Department of Human Services (DHS) Health Services Advisory Council (HSAC) was created to advise the agency regarding health services covered under Minnesota Health Care Programs (MHCP) including Medical Assistance and MinnesotaCare. Authority for the development of the Council comes from Minnesota Statutes, 256B.0625, subdivision.3c.

Objective

The Council will advise DHS regarding evidence-based decision-making and provide leadership designing health care benefit and coverage policies for Minnesota’s publicly funded health care programs.

Guiding Principles

Quality of Care

• Quality of medical care for the patients served by DHS is the primary concern of the agency and this Council.
• The use of evidence will guide this Council and the agency. Scientific evidence will be sought, and conclusions drawn concerning the effect of services on health outcomes.
  • Consideration will be given to available scientific evidence, professional standards, expert opinions, safety, and clinical effectiveness.
  • Decisions are flexible to permit exceptions and take clinical circumstances, improvements in care and changes in literature into consideration.
  • Consensus among the medical community can be used and play a role when no definitive evidence exists or evidence is insufficient at the present time.
• Health care services and technology must improve the net health outcome.
  • A recommendation necessitates good evidence that the procedure is effective in reducing morbidity and mortality: medical benefits must outweigh risks.
  • Services must be as beneficial as any established alternative and improvement must be attainable outside the investigational setting.

Value of Care

• Reasoned and defensible coverage decisions are essential for a fairer and more efficient health care system.
• Cost-effectiveness will guide decision-making.  Cost-effective services and technologies are considered to be:
  • At least as effective and less costly than alternatives.
  • More effective and more costly than alternatives, but resultant patient outcomes justify additional expenditure.
  • Less effective and less costly than alternatives, but resultant patient outcomes from the use of more expensive alternatives do not justify additional expenditures.

Council and DHS Process

• The process is transparent and public.
• Recommendations made by the Council are subject to agency approval. DHS will communicate with the Council regarding final decisions on all recommendations.
• Recommendations must be practical and feasible, and coverage policy should be equivalent across all delivery systems.

Membership

HSAC membership comprises:

• Seven voting members who are licensed physicians actively engaged in the practice of medicine in Minnesota, one of whom must be actively engaged in the treatment of persons with mental illness, and three of whom must represent health plans currently under contract to serve Medical Assistance recipients.
• Two voting members who are physician specialists actively practicing their specialty in Minnesota.
• Two voting members who are non-physician health care professionals licensed or registered in their profession and actively engaged in the practice of their profession in Minnesota.
• One consumer who shall serve as a voting member.
• The DHS Commissioner’s MHCP Medical Director who shall serve as a nonvoting member. 

Members of HSAC shall not be employed by DHS, except for the MHCP Medical Director.

Terms and Compensation

• Members shall serve staggered three-year terms, with one-third of the voting members’ terms expiring annually. Members may be reappointed by the Commissioner.
• The HSAC will meet nine months per year. Meetings will not be held in June, August and December.
• An honorarium of $200 per meeting and reimbursement for mileage and parking shall be paid to each committee member in attendance, except the MHCP Medical Director.
• The HSAC does not expire as provided in Minnesota Statutes 15.059, subdivision 6.

Responsibilities

• Attend all meetings. If a member misses two meetings without good reason, the DHS will discuss this with the member and consider appointment of a new member.
• Bring concerns of the community to the attention of the Chair, MHCP Medical Director, and DHS staff.
• Take part in discussions.
• Actual conflict of interest or the appearance of conflict of interest may exist in certain situations. Members should disclose, orally in a HSAC meeting, whenever actual conflict or the perception of conflict of interest occurs. Members will then refrain from the participation in discussion of and voting on motions pertaining to the matter. Members and guest presenters will also be required to sign a conflict of interest disclosure statement.
• Review the HSAC agenda and information before meetings and prepare comments or questions.
• Review and make recommendations on proposals presented by the department related to clinical issues, evidence-based practice guidelines, legislation and other DHS policies according to the information under the Guiding Principles heading on this webpage.

The Health Services Advisory Council (HSAC) vigorously endorses a public, transparent process. The following set of principles and procedures is proposed to facilitate this goal of transparency.

Principles

Public comment

• HSAC vigorously endorses public comment from stakeholders at its meetings.
• HSAC adheres to public disclosure of conflicts of interest.
• HSAC is chartered by the legislature to provide evidence-based leadership in designing health care benefit and coverage policies for Minnesota’s health care programs. Recognizing this, HSAC encourages public comment to be based in evidence, rather than anecdotal examples.
• HSAC recognizes the value of an extemporaneous interchange between HSAC members and presenters and experts, as moderated by the chair to allow for the most productive use of meeting time.
• Discussion to provide evidence and to clarify the current practice has been and will continue to be separate from the subsequent, public deliberations of the council.

Clinical experts

• It is the council’s primary goal to have thoughtful, evidence-based discussion to inform its policy recommendations.
• The goal of including clinical expertise is best met through inviting relevant clinical experts to specific meetings, as warranted by the complexity of the subject under discussion.
• HSAC encourages specialty societies and other organizations to provide clinical expertise. 

Public access to meeting information
HSAC is committed to making documentation from its proceedings available for public review.

Processes

• At the discretion of the chair or the council, HSAC will invite relevant clinical experts to specific meetings, as warranted by the complexity of the subject under discussion. HSAC shall vote to solicit relevant clinical experts at the request of any external stakeholder.
• HSAC will encourage and allow for an extemporaneous exchange between HSAC members and invited clinical experts, guest presenters, and those offering public comment, as moderated by the chair. This discussion is separate from the subsequent, public deliberations of the council.
• HSAC meeting minutes, evidence summaries and legislative reports are made available on the webpage.
• Written comments, either solicited by HSAC or contributed by stakeholders, are requested to be submitted three days before the pertinent HSAC meeting. All comments will be distributed to HSAC members. The comments will also be made available on the webpage while the subject is under discussion. Items, including meeting agendas, are added to the webpage on a monthly basis, seven days before HSAC meetings. Comments should be submitted to staff 10 days before a meeting to be included in that month’s webpage material.

The 2012 Legislature directed HSAC to recommend coverage for evidence-based treatments for people with autism spectrum disorders (ASD) (Minnesota Session Laws, chapter 247, section 26). Council members discussed the issue at meetings from June through December 2012. The following is the council’s final report to the DHS commissioner:

Autism spectrum disorders: Recommendations for coverage from HSAC to DHS commissioner, Feb. 2013 (DHS-6181) (PDF)

To inform HSAC members’ discussion on select issues, DHS may prepare a report summarizing evidence of the efficiency and effectiveness of certain procedures for certain diagnoses. Refer to the list of evidence summaries and legislative reports.

The Dental Services Advisory Committee is a subcommittee of HSAC.

Contact HSAC staff by mail or email:
Minnesota Department of Human Services
P.O. Box 64983
St. Paul, MN 55164-0983

Contact HSAC staff by emailing hsac@state.mn.us.