2016 -- S 2524

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LC004712

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2016

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A N   A C T

RELATING TO STATE AFFAIRS AND GOVERNMENT - CATASTROPHIC HEALTH

INSURANCE PLAN ACT

     Introduced By: Senators Nesselbush, Miller, Jabour, Crowley, and Sosnowski

     Date Introduced: February 25, 2016

     Referred To: Senate Health & Human Services

     It is enacted by the General Assembly as follows:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

proposed rate increase.

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

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

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

unit of the attorney general's office. Any such public hearing shall commence within sixty (60)

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

hearing, published by the commissioner in a newspaper or newspapers having aggregate general

circulation throughout the state at least ten (10) days prior to the hearing. The notice shall contain

a description of the rates proposed to be charged and/or the rating formula proposed to be used

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

LC004712 - Page 2 of 14

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

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

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

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

witnesses fees.

     (d) Procedures:

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

and/or the rating formula proposed to be used are consistent with the proper conduct of its

business and with the interest of the public.

     (2) Any documents presented in support of a filing of proposed rates and/or the rating

formula proposed to be used under this section shall be made available for public examination at

a time and place that the commissioner may deem reasonable.

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

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

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

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

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

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

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

modification of the rates proposed to be charged and/or the rating formula proposed to be used by

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

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

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

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

rates proposed to be charged and/or the rating formula proposed to be used by the applicant.

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

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

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

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

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

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

hold a public hearing in any instance where the rates proposed in the filing for the annual rate

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

ten percent (10%) or more, or in excess of the threshold trend increase established in subsection

LC004712 - Page 3 of 14

(f)(1) of this section. The commissioner shall require that any filing for a rate increase for

products offered in the individual market shall include the calculation of both the "overall average

rate increase" and the "threshold trend increase" in order to determine whether a public hearing is

required.

     (1) For the purposes of this section, the "threshold trend increase" shall be two percent

(2%) plus the annualized trend factor weighted by the actual experience allowed per member per

month ("PMPM") as both are set forth in part II of the uniform rate review template approved in

the most recent rate year. If the uniform rate review template is modified, a calculation should be

performed that produces comparable results.

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

be based on the proposed essential health benefit base rate for a twenty-one (21) year old at a

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

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

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

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

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

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

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

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

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

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

that subsequent calendar year.

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

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

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

subsection (g) of this section. The commissioner shall notify the attorney general of their final

deferral decision.

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

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

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

(administrative procedures act).

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

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

charged and/or the rating formula to be used. Public comment shall be solicited upon not less than

LC004712 - Page 4 of 14

ten (10) days written notice prior to the date that either:

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

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

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

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

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

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

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

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

may deem reasonable.

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

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

stenographic reporting, and expert fees, regardless of whether a public hearing is held. The

applicant shall bear reasonable expenses of the attorney general in relation to any public hearing

conducted pursuant to this section. The applicant shall bear reasonable expenses of the attorney

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

LC004712 - Page 5 of 14

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

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

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

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

unit of the attorney general's office. Any such public hearing shall commence within sixty (60)

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

hearing, published by the commissioner in a newspaper or newspapers having aggregate general

circulation throughout the state at least ten (10) days prior to the hearing. The notice shall contain

a description of the rates proposed to be charged and/or the rating formula proposed to be used

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

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

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

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

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

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

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

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

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

office of the health insurance commissioner.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

LC004712 - Page 6 of 14

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

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

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

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

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

stenographic reporting, and expert witnesses fees.

     (d) Procedures:

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

and/or the rating formula proposed to be used are consistent with the proper conduct of its

business and with the interest of the public.

     (2) Any documents presented in support of a filing of proposed rates and/or the rating

formula proposed to be used under this section shall be made available for public examination at

a time and place that the commissioner may deem reasonable.

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

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

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

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

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

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

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

modification of the rates proposed to be charged and/or the rating formula proposed to be used by

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

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

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

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

rates proposed to be charged and/or the rating formula proposed to be used by the applicant.

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

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

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

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

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

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

hold a public hearing in any instance where the rates proposed in the filing for the annual rate

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

LC004712 - Page 7 of 14

ten percent (10%) or more, or in excess of the threshold trend increase established in subsection

(f)(1) of this section. The commissioner shall require that any filing for a rate increase for

products offered in the individual market shall include the calculation of both the "overall average

rate increase" and the "threshold trend increase" in order to determine whether a public hearing is

required.

     (1) For the purposes of this section, the "threshold trend increase" shall be two percent

(2%) plus the annualized trend factor weighted by the actual experience allowed per member per

month ("PMPM") as both are set forth in part II of the uniform rate review template approved in

the most recent rate year. If the uniform rate review template is modified, a calculation should be

performed that produces comparable results.

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

be based on the proposed essential health benefit base rate for a twenty-one (21) year old at a

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

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

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

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

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

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

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

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

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

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

that subsequent calendar year.

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

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

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

subsection (g) of this section. The commissioner shall notify the attorney general of their final

deferral decision.

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

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

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

(administrative procedures act).

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

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

LC004712 - Page 8 of 14

charged and/or the rating formula to be used. Public comment shall be solicited upon not less than

ten (10) days written notice prior to the date that either:

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

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

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

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

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

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

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

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

may deem reasonable.

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

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

stenographic reporting, and expert fees, regardless of whether a public hearing is held. The

applicant shall bear reasonable expenses of the attorney general in relation to any public hearing

conducted pursuant to this section. The applicant shall bear reasonable expenses of the attorney

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

LC004712 - Page 9 of 14

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

rates or rating formula shall be pursuant to this section.

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

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

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

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

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

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

insurer, dental insurer, or health maintenance organization subject to title 27, shall be filed at the

office of the health insurance commissioner (hereinafter the "commissioner"). The rates proposed

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

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

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

office. The applicant shall be required to establish that the rates proposed to be charged and/or the

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

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

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

which time notice of such determination shall be sent to the insurance advocacy unit of the

attorney general’s office. In the event there is a public hearing, the attorney general may engage

LC004712 - Page 10 of 14

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

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

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

days written notice prior to the hearing, published by the commissioner in a newspaper or

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

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

the rating formula proposed to be used and a copy of the notice shall be sent to the applicant and

to the attorney general. Any documents presented in support of the filing under this section shall

be made available for public examination at any time and place that the commissioner may deem

reasonable.

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

hold a public hearing in any instance where the rates proposed in the filing for the annual rate

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

ten percent (10%) or more, or in excess of the threshold trend increase established in subsection

(b)(1) of this section. The commissioner shall require that any filing for a rate increase for

products offered in the individual market shall include the calculation of both the "overall average

rate increase" and the "threshold trend increase" in order to determine whether a public hearing is

required.

     (1) For the purposes of this section, the "threshold trend increase" shall be two percent

(2%) plus the annualized trend factor weighted by the actual experience allowed per member per

month ("PMPM") as both are set forth in part II of the uniform rate review template approved in

the most recent rate year. If the uniform rate review template is modified, a calculation should be

performed that produces comparable results.

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

be based on the proposed essential health benefit base rate for a twenty-one (21) year old at a

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

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

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

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

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

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

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

(b) of this section or §§27-19-6(f) and 27-20-6(f) until the subsequent calendar year, with the

provision that one of the deferred applicants shall be required to have a public hearing in the

LC004712 - Page 11 of 14

subsequent year, whether or not the applicants’ filing satisfies the requirements of subsection (b)

of this section or §§27-19-6(f) and 27-20-6(f) in that subsequent calendar year.

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

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

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

subsection (c) of this section. The commissioner shall notify the attorney general of their final

deferral decision.

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

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

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

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

documents which they deem relevant. The public hearing shall be held in accordance with the

provisions of chapter 35 of title 42 (administrative procedures act). Any designee who shall

conduct a hearing pursuant to this section shall report their findings in writing to the

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

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

and/or the rating formula proposed to be used by the applicant. The recommended decision shall

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

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

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

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

modify the filing.

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

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

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

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

(administrative procedures act).

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

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

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

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

designee as appointed by the director shall be paid by the insurer(s) requesting changes in the

rates.

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

LC004712 - Page 12 of 14

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

charged and/or the rating formula to be used. Public comment shall be solicited upon not less than

ten (10) days written notice prior to the date that either:

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

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

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

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

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

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

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

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

may deem reasonable.

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

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

stenographic reporting, and expert fees, regardless of whether a public hearing is held. The

applicant shall bear reasonable expenses of the attorney general in relation to any public hearing

conducted pursuant to this section. The applicant shall bear reasonable expenses of the attorney

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

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

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO STATE AFFAIRS AND GOVERNMENT - CATASTROPHIC HEALTH

INSURANCE PLAN ACT

***

     This act would require a public hearing, with some exceptions, for all insurers or health

maintenance organizations who propose rate increases for health or dental insurance coverage in

the individual market. It would also require the insurers requesting the rate increases to bear the

reasonable expenses incurred by the attorney general or the health insurance commissioner in

considering the rate changes, whether a hearing was held or not. Further, it would give the

commissioner the power to subpoena witnesses, documents and other relevant information in

determining whether to approve, disapprove or modify the requested changes.

     This act would take effect on January 1, 2017.

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