2015 -- S 0487 SUBSTITUTE A

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LC001866/SUB A/2

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2015

____________

A N   A C T

RELATING TO INSURANCE - RATE REVIEW ACT

     

     Introduced By: Senator Maryellen Goodwin

     Date Introduced: February 26, 2015

     Referred To: Senate Health & Human Services

     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

19

proposed rate increase.

 

1

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

2

determine, subject to the provisions of section (f) of this section, whether he or she intends to

3

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

4

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

5

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

6

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

7

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

8

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

9

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

10

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

11

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

12

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

13

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

14

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

15

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

16

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

17

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

18

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

19

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

20

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

21

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

22

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

23

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

24

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

25

deem reasonable.

26

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

27

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

28

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

29

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

30

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

31

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

32

commissioner within a reasonable time following the conclusion of the hearing with a

33

recommendation for approval, disapproval, or modification of the rates proposed to be charged by

34

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

 

LC001866/SUB A/2 - Page 2 of 12

1

following the issuance of the recommended decision or, if the commissioner hears the application

2

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

3

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

4

rates proposed to be charged by the applicant.

5

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

6

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

7

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

8

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

9

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

10

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

11

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

12

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

13

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

14

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

15

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

16

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

17

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

18

shall be based on the proposed essential health benefit base rate for a twenty-one year old at a

19

silver actuarial value of seventy percent (70%), hereinafter referred to as the "EHB base rate". To

20

calculate the overall average rate increase, the applicant shall divide the proposed EHB base rate

21

by the EHB base rate approved in the prior year. The commissioner shall require this calculation

22

to be provided as part of the applicant's individual market rate filing.

23

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

24

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

25

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

26

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

27

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

28

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

29

that subsequent calendar year.

30

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

31

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

32

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

33

subsection (g) of this section.

34

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

 

LC001866/SUB A/2 - Page 3 of 12

1

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

2

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

3

(administrative procedures act).

4

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

5

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

6

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

7

the date that either:

8

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

9

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

10

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

11

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

12

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

13

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

14

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

15

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

16

may deem reasonable.

17

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

18

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

19

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

20

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

21

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

22

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

23

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

24

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

25

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

26

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

27

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

28

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

29

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

30

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

31

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

32

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

33

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

34

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

 

LC001866/SUB A/2 - Page 4 of 12

1

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

2

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

3

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

4

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

5

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

6

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

7

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

8

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

9

determine, subject to the provisions of section (f) of this section, whether he or she intends to

10

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

11

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

12

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

13

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

14

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

15

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

16

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

17

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

18

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

19

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

20

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

21

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

22

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

23

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

24

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

25

office of the health insurance commissioner.

26

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

27

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

28

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

29

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

30

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

31

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

32

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

33

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

34

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

 

LC001866/SUB A/2 - Page 5 of 12

1

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

2

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

3

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

4

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

5

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

6

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

7

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

8

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

9

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

10

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

11

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

12

stenographic reporting, and expert witnesses fees.

13

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

14

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

15

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

16

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

17

deem reasonable.

18

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

19

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

20

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

21

witnesses, compel their attendance, and require the production of 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

24

commissioner within a reasonable time following the conclusion of the hearing with a

25

recommendation for approval, disapproval, or modification of the rates proposed to be charged by

26

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

27

following the issuance of the recommended decision or, if the commissioner hears the application

28

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

29

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

30

rates proposed to be charged by the applicant.

31

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

32

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

33

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

34

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

 

LC001866/SUB A/2 - Page 6 of 12

1

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

2

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

3

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

4

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

5

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

6

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

7

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

8

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

9

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

10

shall be based on the proposed essential health benefit base rate for a twenty-one year old at a

11

silver actuarial value of seventy percent (70%), hereinafter referred to as the "EHB base rate". To

12

calculate the overall average rate increase, the applicant shall divide the proposed EHB base rate

13

by the EHB base rate approved in the prior year. The commissioner shall require this calculation

14

to be provided as part of the applicant's individual market rate filing.

15

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

16

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

17

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

18

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

19

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

20

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

21

that subsequent calendar year.

22

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

23

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

24

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

25

subsection (g) of this section.

26

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

27

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

28

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

29

(administrative procedures act).

30

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

31

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

32

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

33

the date that either:

34

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

 

LC001866/SUB A/2 - Page 7 of 12

1

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

2

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

3

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

4

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

5

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

6

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

7

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

8

may deem reasonable.

9

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

10

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

11

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

12

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

13

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

14

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

15

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

16

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

17

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

18

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

19

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

20

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

21

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

22

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

23

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

24

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

25

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

26

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

27

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

28

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

29

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

30

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

31

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

32

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

33

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

34

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

 

LC001866/SUB A/2 - Page 8 of 12

1

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

2

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

3

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

4

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

5

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

6

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

7

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

8

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

9

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

10

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

11

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

12

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

13

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

14

rates or rating formula shall be pursuant to this section.

15

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

16

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

17

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

18

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

19

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

20

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

21

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

22

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

23

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

24

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

25

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

26

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

27

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

28

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

29

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

30

determine, subject to subsection (b) of this section, whether he or she intends to hold a public

31

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

32

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

33

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

34

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

 

LC001866/SUB A/2 - Page 9 of 12

1

such public hearing shall commence within sixty (60) days after receipt of the filing, the

2

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

3

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

4

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

5

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

6

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

7

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

8

commissioner may deem reasonable.

9

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

10

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

11

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

12

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

13

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

14

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

15

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

16

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

17

shall be based on the proposed essential health benefit base rate for a twenty-one year old at a

18

silver actuarial value of seventy percent (70%), hereinafter referred to as the "EHB base rate". To

19

calculate the overall average rate increase, the applicant shall divide the proposed EHB base rate

20

by the EHB base rate approved in the prior year. The commissioner shall require this calculation

21

to be provided as part of the applicant's individual market rate filing.

22

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

23

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

24

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

25

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

26

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

27

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

28

that subsequent calendar year.

29

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

30

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

31

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

32

with subsection (c) of this section.

33

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

34

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

 

LC001866/SUB A/2 - Page 10 of 12

1

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

2

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

3

papers, records, correspondence, or other documents which he or she deems relevant. The public

4

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

5

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

6

or her findings in writing to the commissioner within a reasonable time following the conclusion

7

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

8

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

9

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

10

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

11

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

12

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

13

     (f) Notwithstanding any other provisions 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 of any health insurer, dental insurer, or health maintenance organization

16

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

17

(administrative procedures act).

18

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

19

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

20

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

21

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

22

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

23

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

24

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

25

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

26

date that either:

27

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

28

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

29

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

30

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

31

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

32

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

33

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

34

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

 

LC001866/SUB A/2 - Page 11 of 12

1

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

2

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

3

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

4

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

5

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

6

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

7

     SECTION 4. This act shall take effect on January 1, 2016.

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LC001866/SUB A/2 - Page 12 of 12

EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE - RATE REVIEW 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, 2016.

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LC001866/SUB A/2

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LC001866/SUB A/2 - Page 13 of 12