Attorney General Peter F. Kilmartin today filed an Administrative Appeal in Rhode Island Superior Court seeking review of the Rhode Island Office of Health Insurance Commissioner's (OHIC) Decision and Amended Decision increasing rates that can be charged by Blue Cross Blue Shield of Rhode Island ("Blue Cross") for its Direct Pay line of business.
The Appeal filed alleges that the decision is erroneous and should be vacated pursuant to R.I. Gen. Laws § 42-35-15(g)(1)-(6) because the Commissioner, in her Decision and Amended Decision, acted unlawfully, arbitrarily, and committed errors of law.
"As statutory representative of consumers, it is my responsibility and priority to protect the rights of Rhode Island ratepayers," said Attorney General Peter F. Kilmartin. "Having exhausted all administrative remedies in attempting to resolve this matter at the agency level, our Office has filed this Appeal. The state laws guiding OHIC's decision making requirements are clear, and we do not believe they were followed in this case."
On August 7, 2015, Attorney General Kilmartin filed a Motion for Reconsideration with the Health Insurance Commissioner asking for a reconsideration of her August 3, 2015 decision approving a rate increase requested by Blue Cross Blue Shield of Rhode Island ("Blue Cross") for its Direct Pay line of business. The Direct Pay market is for those who pay for their own coverage, without the help of employers, with the exception of those insured on the State's Health Care Exchange who may qualify for Medicaid subsidies. The Commissioner's Decision will allow Blue Cross to increase rates by 10 percent beginning January 1, 2016.
Attorney General Kilmartin filed the Motion for Reconsideration on the grounds that the Order does not comply with a state law mandating that agency orders must contain "concise and explicit statement of the underlying facts supporting the findings of fact." Although the Hearing Officer's Report and Recommendation was 35 pages long, giving an in-depth explanation for the conclusions, the Commissioner's final decision that will result in a 10 percent increase was only two pages long, and contained no independent reasoning.
Additionally, it was brought to the attention of Blue Cross and Attorney General Kilmartin that the Commissioner had engaged in closed-door communication with one of the parties involved without the knowledge of the other parties.
The Motion for Reconsideration requested that the Commissioner provide support for her Order, or alternatively, adopt the report and recommendations of the Hearing Officer in full.
In response to Attorney General Kilmartin's Motion for Reconsideration, the Commissioner issued an Amended Order and Decision on August 19, 2015, which essentially reached the same result as the August 3, 2015 Decision, but provided some findings of fact and conclusions of law in an effort to support the Commissioner's Amended Decision.
The Appeal filed today respectfully requests that the Court stay the Amended Decision and order the Commissioner not to post of approve any rates for Blue Cross's Direct Pay line of business until this matter is resolved and require the Commissioner to implement the Report and Recommendation of the Hearing Officer to determine the appropriate premium rates for Blue Cross's Direct Pay subscribers. It also requests that the Court reverse and vacate the Decision and Amended Decision of the Commissioner and adopt the complete Report and Recommendation of the Hearing Officer.