2016 -- H 7510 SUBSTITUTE A

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LC004471/SUB A

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2016

____________

A N   A C T

RELATING TO STATE AFFAIRS AND GOVERNMENT - CATASTROPHIC HEALTH

INSURANCE PLAN ACT

     

     Introduced By: Representatives Messier, Morin, Fellela, Azzinaro, and Bennett

     Date Introduced: February 10, 2016

     Referred To: House Corporations

     (Attorney General)

It is enacted by the General Assembly as follows:

1

     SECTION 1. Section 27-19-6 of the General Laws in Chapter 27-19 entitled "Nonprofit

2

Hospital Service Corporations" is hereby amended to read as follows:

3

     27-19-6. Rates charged subscribers -- Reserves. -- (a) Public hearings General: - The

4

rates proposed to be charged or a rating formula proposed to be used by any corporation

5

organized under this chapter to employers, the state or any political subdivision of the state, or

6

individuals, shall be filed by the corporation at the office of the health insurance commissioner

7

(hereinafter referred to as the "commissioner"). Within sixty (60) days after receipt of the

8

application, the commissioner, or his or her designee shall hold a hearing on all rates proposed for

9

health insurance coverage offered in the individual market as defined in § 27-18.5-2 upon not less

10

than ten (10) days written notice prior to the hearing. With regard to any other rates subject to the

11

commissioner's jurisdiction the commissioner, or his or her designee, may hold a hearing upon

12

not less than ten (10) days written notice prior to the hearing. The notice shall be published by the

13

commissioner in a newspaper or newspapers having aggregate general circulation throughout the

14

state at least ten (10) days prior to the hearing. The notice shall contain a description of the rates

15

proposed to be charged and a copy of the notice shall be sent to the applicant and to the

16

department of the attorney general. In addition, the applicant shall provide by mail, at least ten

17

(10) days prior to the hearing, notice of the proposed rate increase for health insurance coverage

18

offered in the individual market as defined in § 27-18.5-2 to all subscribers subject to the

 

1

proposed rate increase.

2

     (b) Public hearings: Within ten (10) days after receipt of a filing, the commissioner shall

3

determine, subject to the provisions of section (f) of this section, whether they intend to hold a

4

public meeting or a public hearing at which time notice of such determination shall be sent to the

5

insurance advocacy unit of the attorney general. Any such public hearing shall commence within

6

sixty (60) days after receipt of the application, upon not less than ten (10) days written notice

7

prior to the hearing, published by the commissioner in a newspaper or newspapers having

8

aggregate general circulation throughout the state at least ten (10) days prior to the hearing. The

9

notice shall contain a description of the rates proposed to be charged and a copy of the notice

10

shall be sent to the applicant and to the department of the attorney general. In the event there is a

11

public hearing, the attorney general may engage the services of any expert or consultant

12

necessary to assist in reviewing the filing, including having the ability to seek additional relevant

13

information from the filer. All public hearings held pursuant to this section shall be held in

14

accordance with the provisions of chapter 35 of title 42 (administrative procedures act).

15

     (b)(c) Filings with the Attorney General's Office: - The applicant shall provide a copy of

16

the filing on all rates proposed for health insurance coverage offered in the individual market as

17

defined in § 27-18.5-2 to the Insurance Advocacy Unit of the Attorney General's Office

18

simultaneously with the filing at the office of the health insurance commissioner.

19

     (c)(d) Procedures: - At any hearing held under this section, the applicant shall be required

20

to establish that the rates proposed to be charged or the rating formula to be used are consistent

21

with the proper conduct of its business and with the interest of the public.

22

     Rates proposed to be charged by any corporation organized under this chapter shall be

23

sufficient to maintain total reserves in a dollar amount sufficient to pay claims and operating

24

expenses for not less than one month. Those reserves shall be computed as of each December

25

31st, and a report setting forth the computation shall be submitted to the commissioner together

26

with the corporation's Rhode Island annual statement to the commissioner. Any documents

27

presented in support of a filing of proposed rates under this section shall be made available for

28

inspection by any party entitled to participate in a hearing or admitted as an intervenor in a

29

hearing or such conditions as the commissioner may prescribe provided under this section at a

30

time and at a place as the commissioner may deem reasonable. The commissioner, or his or her

31

designee, upon the hearing, may administer oaths, examine and cross-examine witnesses, receive

32

oral and documentary evidence, and shall have the power to subpoena witnesses, compel their

33

attendance, and require the production of books, papers, records, correspondence, or other

34

documents which he or she deems relevant. The commissioner shall issue a decision as soon as is

 

LC004471/SUB A - Page 2 of 13

1

reasonably possible following the completion of the hearing. The decision may approve,

2

disapprove, or modify the rates proposed to be charged by the applicant. Applicants requesting

3

changes in rates shall underwrite the reasonable expenses of the commissioner in connection with

4

the hearing, including any costs related to advertisements, stenographic reporting, and expert

5

witnesses fees.

6

     (1) The applicant shall be required to establish that the rates proposed to be charged are

7

consistent with the proper conduct of its business and with the interest of the public.

8

     (2) Any documents presented in support of a filing of proposed rates under this section

9

shall be made available for public examination at a time and place that the commissioner may

10

deem reasonable.

11

     (3) If a public hearing is held pursuant to subsection (b) of this section, the commissioner,

12

or their designee, upon the hearing, may administer oaths, examine and cross-examine witnesses,

13

receive oral and documentary evidence, and shall have the power to subpoena witnesses, compel

14

their attendance, and require the production of books, papers, records, correspondence, or other

15

documents which they deem relevant. Any designee who shall conduct a hearing pursuant to this

16

section shall report their findings in writing to the commissioner within a reasonable time

17

following the conclusion of the hearing with a recommendation for approval, disapproval, or

18

modification of the rates proposed to be charged by the applicant. The commissioner shall make

19

and issue a decision not later than ten (10) days following the issuance of the recommended

20

decision or, if the commissioner hears the application without the appointment of a designee, as

21

soon as is reasonably possible following the completion of the hearing on the proposed rate

22

change. The decision may approve, disapprove, or modify the rates proposed to be charged by the

23

applicant.

24

     (d)(e) The term "designee" as used in this section shall mean a person who is impartial, a

25

member in good standing of the Rhode Island bar and a person who is sufficiently acquainted

26

with the rules of evidence as used in the superior court of the state so as to enable that person to

27

conduct a hearing as designee of the commissioner. The reasonable per diem cost of the designee

28

as appointed by the commissioner shall be paid by the applicant requesting changes in the rates.

29

     (f) Notwithstanding any provision of this section to the contrary, the commissioner shall

30

hold a public hearing in any instance where the applicant covers ten thousand (10,000) or more

31

enrolled individuals in the individual market, and the rates proposed in the filing for the annual

32

rate increase for products offered in the individual market produce an overall average rate

33

increase of ten percent (10%) or more. The commissioner shall require that any filing for a rate

34

increase for products offered in the individual market shall include the calculation of the "overall

 

LC004471/SUB A - Page 3 of 13

1

average rate increase" in order to determine whether a public hearing is required.

2

     (1) For the purposes of this section, the calculation of the "overall average rate increase"

3

shall be based on the overall average increase percent weighted by member premiums, excluding

4

the effects of age scale increases. To calculate the overall average rate increase, the applicant

5

shall multiply the proposed rate increase by product times the total monthly renewing premium

6

for each product, and then divide the product by the sum of monthly renewing premiums for all

7

products. The commissioner shall require this calculation to be provided as part of the applicant's

8

individual market rate filing.

9

     (g) In the event that subsection (f) of this section in combination with §42-62-13(b)

10

would result in more than one public hearing in any given calendar year, the commissioner may

11

defer one or more public hearing(s) for an applicant resulting from subsection (f) of this section

12

or §42-62-13(b) until the subsequent calendar year, with the provision that one of the deferred

13

applicants shall be required to have a public hearing in the subsequent year, whether or not the

14

applicants' filing satisfies the requirements of subsection (f) of this section or §42-62-13(b) in that

15

subsequent calendar year.

16

     (h) The commissioner shall notify the attorney general of the filing(s) to be deferred and

17

the attorney general shall be given the opportunity to provide written comments and

18

recommendations to the commissioner regarding any such filing(s) deferred in accordance with

19

subsection (g) of this section.

20

     (i) Notwithstanding any other provision of law, the filing of proposed rates or a rating

21

formula and the holding and conducting of any public hearing in connection with these proposed

22

rates or rating formula shall be held in accordance with the provisions of chapter 35 of title 42

23

(administrative procedures act).

24

     (j) Public comment. Whether or not a public hearing is held pursuant to subsection (f) of

25

this section, the commissioner shall solicit public comment regarding the rates proposed to be

26

charged. Public comment shall be solicited upon not less than ten (10) days written notice prior to

27

the date that either:

28

     (1) A public meeting at which verbal comments may be provided; or

29

     (2) That written comment must be received by the commissioner. The notice shall contain

30

a description of the rates proposed to be charged or the formula proposed to be used, and a copy

31

of the notice shall be sent to the applicant and to the insurance advocacy unit of the department of

32

attorney general. The attorney general shall be permitted to conduct discovery in relation to the

33

actuarial analysis and actuarial assumptions of the filer regarding any filing in the individual

34

market as defined in §27-18.5-2. Any documents presented in support of the filing under this

 

LC004471/SUB A - Page 4 of 13

1

section shall be made available for public examination at a time and place that the commissioner

2

may deem reasonable.

3

     (k) The applicant shall bear reasonable expenses of the commissioner in connection with

4

a filing made pursuant to this section, including any costs related to advertisements, stenographic

5

reporting, and expert fees, regardless of whether a public hearing is held. The applicant shall bear

6

reasonable expenses of the attorney general in relation to any public hearing conducted pursuant

7

to this section. The applicant shall bear reasonable expenses of the attorney general in relation to

8

any filing in the individual market that is not subject to a public hearing.

9

     SECTION 2. Section 27-20-6 of the General Laws in Chapter 27-20 entitled "Nonprofit

10

Medical Service Corporations" is hereby amended to read as follows:

11

     27-20-6. Rates charged subscribers -- Reserves -- Hearing by director. -- (a) Public

12

hearings General: - The rates proposed to be charged or a rating formula proposed to be used by

13

any corporation organized under this chapter to its subscribers, employers, the state or any

14

political subdivision of the state, or individuals, shall be filed by the corporation at the office of

15

the health insurance commissioner (hereinafter referred to as the "commissioner"). Within sixty

16

(60) days after receipt of the application, the commissioner, or his or her designee, shall hold a

17

hearing on all rates proposed for health insurance coverage offered in the individual market as

18

defined in § 27-18.5-2 upon not less than ten (10) days written notice prior to the hearing. With

19

regard to any other rates or rating formula subject to the commissioner's jurisdiction the

20

commissioner, or his or her designee, may hold a hearing upon not less than ten (10) days written

21

notice prior to the hearing. The notice shall be published by the commissioner in a newspaper or

22

newspapers having aggregate general circulation throughout the state at least ten (10) days prior

23

to the hearing. The notice shall contain a description of the rates proposed to be charged and a

24

copy of the notice shall be sent to the applicant and to the department of the attorney general. In

25

addition, the applicant shall provide by mail, at least ten (10) days prior to the hearing, notice of

26

the proposed rate increase for health insurance coverage offered in the individual market as

27

defined in § 27-18.5-2 to all subscribers subject to the proposed rate increase.

28

     (b) Public hearings: Within ten (10) days after receipt of a filing, the commissioner shall

29

determine, subject to the provisions of section (f) of this section, whether they intend to hold a

30

public meeting or a public hearing at which time notice of such determination shall be sent to the

31

insurance advocacy unity of the attorney general. Any such public hearing shall commence within

32

sixty (60) days after receipt of the application, upon not less than ten (10) days written notice

33

prior to the hearing, published by the commissioner in a newspaper or newspapers having

34

aggregate general circulation throughout the state at least ten (10) days prior to the hearing. The

 

LC004471/SUB A - Page 5 of 13

1

notice shall contain a description of the rates proposed to be charged and a copy of the notice

2

shall be sent to the applicant and to the department of the attorney general. In the event there is a

3

public hearing, the attorney general may engage the services of any expert or consultant

4

necessary to assist in reviewing the filing, including having the ability to seek additional relevant

5

information from the filer. All public hearings held pursuant to this section shall be held in

6

accordance with the provisions of chapter 35 of title 42 (administrative procedures act).

7

     (b)(c) Filings with the Attorney General's Office: - The applicant shall provide a copy of

8

the filing on all rates proposed for health insurance coverage offered in the individual market as

9

defined in § 27-18.5-2 or for a Medicare supplement policy as defined in § 27-18.2-1 to the

10

Insurance Advocacy Unit of the Attorney General's Office simultaneously with the filing at the

11

office of the health insurance commissioner.

12

     (c)(d) Procedures: - At any hearing held under this section, the applicant shall be required

13

to establish that the rates proposed to be charged or the rating formula proposed to be used are

14

consistent with the proper conduct of its business and with the interest of the public.

15

      Rates proposed to be charged by any corporation organized under this chapter shall

16

maintain total reserves in a dollar amount sufficient to pay claims and operating expenses for not

17

less than one month. Those reserves shall be computed as of each December 31st, and a report

18

setting forth the computation shall be submitted to the commissioner together with the

19

corporation's Rhode Island annual statement to the insurance commissioner of the state of Rhode

20

Island. Any documents presented in support of a filing of proposed rates under this section shall

21

be made available for inspection by any party entitled to participate in a hearing or admitted as an

22

intervenor in a hearing on such conditions as the commissioner may prescribe provided pursuant

23

to this section at a time and at a place as the commissioner may deem reasonable. The

24

commissioner, or his or her designee, upon the hearing, may administer oaths, examine and cross

25

examine witnesses, receive oral and documentary evidence, and shall have the power to subpoena

26

witnesses, compel their attendance, and require the production of books, papers, records,

27

correspondence, or other documents which the director deems relevant. The commissioner shall

28

issue a decision as soon as is reasonably possible following completion of the hearing. The

29

decision may approve, disapprove, or modify the rates proposed to be charged by the applicant.

30

Applicants requesting changes in rates shall underwrite the reasonable expenses of the

31

commissioner in connection with the hearing, including any costs related to advertisements,

32

stenographic reporting, and expert witnesses fees.

33

     (1) The applicant shall be required to establish that the rates proposed to be charged are

34

consistent with the proper conduct of its business and with the interest of the public.

 

LC004471/SUB A - Page 6 of 13

1

     (2) Any documents presented in support of a filing of proposed rates under this section

2

shall be made available for public examination at a time and place that the commissioner may

3

deem reasonable.

4

     (3) If a public hearing is held pursuant to subsection (b) of this section, the commissioner,

5

or their designee, upon the hearing, may administer oaths, examine and cross-examine witnesses,

6

receive oral and documentary evidence, and shall have the power to subpoena witnesses, compel

7

their attendance, and require the production of books, papers, records, correspondence, or other

8

documents which they deem relevant. Any designee who shall conduct a hearing pursuant to this

9

section shall report their findings in writing to the commissioner within a reasonable time

10

following the conclusion of the hearing with a recommendation for approval, disapproval, or

11

modification of the rates proposed to be charged by the applicant. The commissioner shall make

12

and issue a decision not later than ten (10) days following the issuance of the recommended

13

decision or, if the commissioner hears the application without the appointment of a designee, as

14

soon as is reasonably possible following the completion of the hearing on the proposed rate

15

change. The decision may approve, disapprove, or modify the rates proposed to be charged by the

16

applicant.

17

     (d)(e) The term "designee" as used in this section shall mean a person who is impartial, a

18

member in good standing of the Rhode Island bar and a person who is sufficiently acquainted

19

with the rules of evidence as used in the superior court of the state so as to enable that person to

20

conduct a hearing as designee of the commissioner. The reasonable per diem cost of the designee

21

as appointed by the commissioner shall be paid by the applicant requesting changes in the rates.

22

     (f) Notwithstanding any provision of this section to the contrary, the commissioner shall

23

hold a public hearing in any instance where the applicant covers ten thousand (10,000) or more

24

enrolled individuals in the individual market, and the rates proposed in the filing for the annual

25

rate increase for products offered in the individual market produce an overall average rate

26

increase of ten percent (10%) or more. The commissioner shall require that any filing for a rate

27

increase for products offered in the individual market shall include the calculation of the "overall

28

average rate increase" in order to determine whether a public hearing is required.

29

     (1) For the purposes of this section, the calculation of the "overall average rate increase"

30

shall be based on the overall average increase percent weighted by member premiums, excluding

31

the effects of age scale increases. To calculate the overall average rate increase, the applicant

32

shall multiply the proposed rate increase by product times the total monthly renewing premium

33

for each product, and then divide the product by the sum of monthly renewing premiums for all

34

products. The commissioner shall require this calculation to be provided as part of the applicant's

 

LC004471/SUB A - Page 7 of 13

1

individual market rate filing.

2

     (g) In the event that subsection (f) of this section in combination with §42-62-13(b)

3

would result in more than one public hearing in any given calendar year, the commissioner may

4

defer one or more public hearing(s) for an applicant resulting from subsection (f) of this section

5

or §42-62-13(b) until the subsequent calendar year, with the provision that one of the deferred

6

applicants shall be required to have a public hearing in the subsequent year, whether or not the

7

applicants' filing satisfies the requirements of subsection (f) of this section or §42-62-13(b) in that

8

subsequent calendar year.

9

     (h) The commissioner shall notify the attorney general of the filing(s) to be deferred and

10

the attorney general shall be given the opportunity to provide written comments and

11

recommendations to the commissioner regarding any such filing(s) deferred in accordance with

12

subsection (g) of this section.

13

     (i) Notwithstanding any other provision of law, the filing of proposed rates or a rating

14

formula and the holding and conducting of any public hearing in connection with these proposed

15

rates or rating formula shall be held in accordance with the provisions of chapter 35 of title 42

16

(administrative procedures act).

17

     (j) Public comment. Whether or not a public hearing is held pursuant to subsection (f) of

18

this section, the commissioner shall solicit public comment regarding the rates proposed to be

19

charged. Public comment shall be solicited upon not less than ten (10) days written notice prior to

20

the date that either:

21

     (1) A public meeting at which verbal comments may be provided; or

22

     (2) That written comment must be received by the commissioner. The notice shall contain

23

a description of the rates proposed to be charged or the formula proposed to be used, and a copy

24

of the notice shall be sent to the applicant and to the insurance advocacy unit of the department of

25

attorney general. The attorney general shall be permitted to conduct discovery in relation to the

26

actuarial analyses and actuarial assumptions of the filer regarding any filing in the individual

27

market as defined in §27-18.5-2. Any documents presented in support of the filing under this

28

section shall be made available for public examination at a time and place that the commissioner

29

may deem reasonable.

30

     (k) The applicant shall bear reasonable expenses of the commissioner in connection with

31

a filing made pursuant to this section, including any costs related to advertisements, stenographic

32

reporting, and expert fees, regardless of whether a public hearing is held. The applicant shall bear

33

reasonable expenses of the attorney general in relation to any public hearing conducted pursuant

34

to this section. The applicant shall bear reasonable expenses of the attorney general relation to

 

LC004471/SUB A - Page 8 of 13

1

any filing in the individual market that is not subject to a public hearing.

2

     SECTION 3. Section 42-62-13 of the General Laws in Chapter 42-62 entitled

3

"Catastrophic Health Insurance Plan Act" is hereby amended to read as follows:

4

     42-62-13. Rates charged. -- (a) The rates proposed to be charged or a rating formula

5

proposed to be used by any insurer or health maintenance organization under this section to

6

employers, the state or any political subdivision of the state, or individuals, shall be filed by the

7

insurer or health maintenance organization at the office of the director of business regulation.

8

This section does not apply to any entity subject to § 27-19-1 et seq., and/or § 27-20-1 et seq. The

9

rates proposed to be charged by those entities shall be governed by the provisions of § 27-19-1 et

10

seq., and/or § 27-20-1 et seq. Within sixty (60) days after receipt of the application, the director,

11

or the director's designee, may hold a hearing upon not less than ten (10) days' written notice

12

prior to the hearings. The notice shall contain a description of the rates proposed to be charged,

13

and a copy of the notice shall be sent to the applicant and to the consumer protection unit of the

14

department of attorney general. At any hearing held under this section, the applicant shall be

15

required to establish that the rates proposed to be charged or the rating formula proposed to be

16

used are consistent with the proper conduct of its business and with the interest of the public. Any

17

documents presented in support of a filing of proposed rates under this section shall be made

18

available for public examination at any time and place that the director may deem reasonable. The

19

director, or the director's designee, upon that hearing may administer oaths, examine and cross-

20

examine witnesses, receive oral and documentary evidence, and shall have the power to subpoena

21

witnesses, compel their attendance and require the production of all books, papers, records,

22

correspondence, or other documents which he or she deems relevant. Any designee who shall

23

conduct a hearing pursuant to this section shall report his or her findings in writing to the director

24

within eighty (80) days of the filing with a recommendation for approval, disapproval, or

25

modification of the rates proposed to be charged by the applicant. The recommended decision

26

shall become part of the record. The director shall make and issue a decision not later than ten

27

(10) days following the issuance of the recommended decision or, if the director hears the

28

application without the appointment of a designee, as soon as is reasonably possible following the

29

completion of the hearing on the proposed rate change. The decision may approve, disapprove, or

30

modify the rates proposed to be charged by the applicant. Insurers requesting changes in rates

31

shall underwrite the reasonable expenses of the department of business regulation in connection

32

with the hearing, including any costs related to advertisements, stenographic reporting, and expert

33

witnesses fees. Notwithstanding any other provisions of law, the filing of proposed rates or a

34

rating formula and the holding and conduct of any hearings in connection with these proposed

 

LC004471/SUB A - Page 9 of 13

1

rates or rating formula shall be pursuant to this section.

2

     (b) Whenever the term "designee" is used in this section, it shall mean a person who is

3

impartial, a member in good standing of the Rhode Island bar and a person who is sufficiently

4

acquainted with the rules of evidence as used in the superior court of the state so as to enable that

5

person to conduct a hearing as designee of the director. The reasonable per diem cost of the

6

designee as appointed by the director shall be paid by the insurers requesting changes in the rates.

7

     The rates proposed to be charged or a rating formula proposed to be used by any health

8

insurer, dental insurer, or health maintenance organization subject to title 27 to employers, the

9

state or any political subdivision of the state, or individuals, shall be filed at the office of the

10

health insurance commissioner (hereinafter referred to as the "commissioner"). The rates

11

proposed to be used by any health insurer, dental insurer, or health maintenance organization in

12

the individual market as defined in §27-18.5-2 shall be filed at the office the of the health

13

insurance commissioner and simultaneously with the attorney general's insurance advocacy unit.

14

The applicant shall be required to establish that the rates proposed to be charged or the rating

15

formula proposed to be used are consistent with the proper conduct of its business and with the

16

interest of the public. Within ten (10) days after receipt of the filing the commissioner shall

17

determine, subject to subsection (b) of this section, whether they intend to hold a public meeting

18

or a public hearing at which time notice of such determination shall be sent to the insurance

19

advocacy unit of the attorney general. In the event there is a public hearing, the attorney general

20

may engage the services of any expert or consultant necessary to assist in reviewing the filing,

21

including having the ability to seek additional relevant information from the filer. Any such

22

public hearing shall commence within sixty (60) days after receipt of the filing. The

23

commissioner, or the commissioner's designee, may hold a hearing upon not less than ten (10)

24

days' prior written notice to the public in a newspaper or newspapers having aggregate general

25

circulation throughout the state. The notice shall contain a description of the rates proposed to be

26

charged, and a copy of the notice shall be sent to the applicant and to the insurance advocacy unit

27

of the department of attorney general. Any documents presented in support of the filing under this

28

section shall be made available for public examination at any time and place that the

29

commissioner may deem reasonable.

30

     (b) Notwithstanding any provision of this section to the contrary, the commissioner shall

31

hold a public hearing in any instance where the applicant covers ten thousand (10,000) or more

32

enrolled individuals in the individual market, and the rates proposed in the filing for the annual

33

rate increase for products offered in the individual market produce an overall average rate

34

increase of ten percent (10%) or more. The commissioner shall require that any filing for a rate

 

LC004471/SUB A - Page 10 of 13

1

increase for products offered in the individual market shall include the calculation of the "overall

2

average rate increase" in order to determine whether a public hearing is required.

3

     (1) For the purposes of this section, the calculation of the "overall average rate increase"

4

shall be based on the overall average increase percent weighted by member premiums, excluding

5

the effects of age scale increases. To calculate the overall average rate increase, the applicant

6

shall multiply the proposed rate increase by product times the total monthly renewing premium

7

for each product, and then divide the product by the sum of monthly renewing premiums for all

8

products. The commissioner shall require this calculation to be provided as part of the applicant's

9

individual market rate filing.

10

     (c) In the event that subsection (b) of this section in combination with §§27-19-6(f) and

11

27-20-6(f) would result in more than one public hearing in any given calendar year, the

12

commissioner may defer one or more public hearing(s) for applicant(s) resulting from subsection

13

(b) or §§27-19-6(f) and 27-20-6(f) until the subsequent calendar year, with the provision that one

14

of the deferred applicants shall be required to have a public hearing in the subsequent year

15

whether or not it satisfies the requirements of subsection (b) or §§27-19-6(f) and 27-20-6(f) for

16

that subsequent calendar year.

17

     (d) The commissioner shall notify the attorney general of the filing(s) to be deferred and

18

the attorney general shall be given the opportunity to provide written comments and

19

recommendations to the commissioner regarding any such filing(s) that is deferred in accordance

20

with subsection (c) of this section.

21

     (e) Public Hearings. If a public hearing is held pursuant to subsection (b) of this section,

22

the commissioner, or the commissioner's designee, upon that hearing may administer oaths,

23

examine and cross-examine witnesses, receive oral and documentary evidence, and shall have the

24

power to subpoena witnesses, compel their attendance and require the production of all books,

25

papers, records, correspondence, or other documents which they deem relevant. The public

26

hearing shall be held in accordance with the provisions of chapter 35 of title 42 (administrative

27

procedures act). Any designee who shall conduct a hearing pursuant to this section shall report

28

their findings in writing to the commissioner within a reasonable time following the conclusion of

29

the hearing with a recommendation for approval, disapproval, or modification of the rates

30

proposed to be charged by the applicant. The recommended decision shall become part of the

31

record. The commissioner shall make and issue a decision not later than ten (10) days following

32

the issuance of the recommended decision or, if the commissioner hears the application without

33

the appointment of a designee, as soon as is reasonably possible following the completion of the

34

hearing on the proposed rate change. The decision may approve, disapprove, or modify the filing.

 

LC004471/SUB A - Page 11 of 13

1

     (f) Notwithstanding any other provisions of law, the filing of proposed rates or a rating

2

formula and the holding and conducting of any public hearing in connection with these proposed

3

rates or rating formula of any health insurer, dental insurer, or health maintenance organization

4

subject to title 27 shall be held in accordance with the provisions of chapter 35 of title 42.

5

     (g) Whenever the term "designee" is used in this section, it shall mean a person who is

6

impartial, a member in good standing of the Rhode Island bar and a person who is sufficiently

7

acquainted with the rules of evidence as used in the superior court of the state so as to enable that

8

person to conduct a hearing as designee of the director. The reasonable per diem cost of the

9

designee as appointed by the director shall be paid by the insurers requesting changes in the rates.

10

     (h) Public comment. Whether or not a public hearing is held pursuant to subsection (b) of

11

this section, the commissioner shall solicit public comment regarding the rates proposed to be

12

used. Public comment shall be solicited upon not less than ten (10) days written notice prior to the

13

date that either:

14

     (1) A public meeting at which verbal comments may be provided; or

15

     (2) That written comment must be received by the commissioner. The notice shall contain

16

a description of the rates proposed to be charged, and a copy of the notice shall be sent to the

17

applicant and to the insurance advocacy unit of the department of attorney general. The attorney

18

general shall be permitted to conduct discovery in relation to the actuarial analysis and actuarial

19

assumptions of the filer regarding any filing in the individual market as defined in §27-18.5-2.

20

Any documents presented in support of the filing under this section shall be made available for

21

public examination at a time and place that the commissioner may deem reasonable.

22

     (i) The applicant shall bear reasonable expenses of the commissioner in connection with a

23

filing made pursuant to this section, including any costs related to advertisements, stenographic

24

reporting, and expert fees, regardless of whether a public hearing is held. The applicant shall bear

25

reasonable expenses of the attorney general in relation to any public hearing conducted pursuant

26

to this section. The applicant shall bear reasonable expenses of the attorney general in relation to

27

any filing in the individual market that is not subject to a public hearing.

28

     SECTION 4. This act shall take effect on January 1, 2017 upon passage.

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LC004471/SUB A

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LC004471/SUB A - Page 12 of 13

EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO STATE AFFAIRS AND GOVERNMENT - CATASTROPHIC HEALTH

INSURANCE PLAN ACT

***

1

     This act would create a uniform rate review procedure for rates proposed to be changed

2

or rating formulas proposed to be used by nonprofit hospital service corporations, nonprofit

3

medical services corporations and the catastrophic health insurance plan requiring public hearings

4

or public meetings with the applicant bearing the reasonable expenses of the filing. This act

5

would not limit the appeal rights of any person or entity that had the right to appeal a final

6

decision of the commissioner under the applicable provisions of titles 27 and 42 relating to health

7

insurance.

8

     This act would take effect on January 1, 2017 upon passage.

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LC004471/SUB A

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LC004471/SUB A - Page 13 of 13