NOTICE OF HEARING &
INITIAL ORDER ON CONDUCT OF HEARING
To: Michael P. Angelini, Esq.
Bowditch & Dewey, LLP
311 Main Street, P.O. Box 15156
Worcester, MA 01615-0156
Jesse M. Caplan, Esq
Epstein Becker & Green
c/o Fallon Community Health Plan, Inc.
10 Chestnut Street
Worcester, MA 01608
Health Care Access Bureau
Division of Insurance
1000 Washington Street
Boston MA 02118-6200
Attorney General Martha Coakley
Office of the Attorney General
One Ashburton Place
Boston, MA 02108
Hearing Scheduled for April 22, 2010
On April 1, 2010, Kevin P. Beagan, Deputy Commissioner, Health Care Access Bureau, disapproved the rate filing for health plans offering health insurance to non-group and small groups that Fallon Community Health Plan ("the HMO") filed on March 2, 2010 ("the Filing"), except for the Core Coverage 1500 HMO product ("April 1 Disapproval"). The HMO has requested a hearing ("HMO's request") concerning the April 1 Disapproval. The hearing will be conducted in accordance with the Formal Rules of the Standard Adjudicatory Rules of Practice and Procedure, 801 CMR 1.00, et seq.
The hearing will commence on April 22, 2010, at 1:30 p.m. at the offices of the Division at 1000 Washington Street, 1st Floor, Boston, MA 02118-6200. The parties should be prepared to clarify the issues to be contested in this case, to identify and schedule any exchange of information, to consider the possibility of obtaining agreement or stipulation as to facts and documents, to identify and schedule witnesses, and to address any other matter which may aid in the disposition of this proceeding.
Any person, not initially a party, who may be substantially and specifically affected by the hearing and wishes to intervene or participate in the hearing shall file a written petition for leave to intervene or participate no later than at the April 22, 2010 hearing. The petition shall state the petitioner's name and address, describe the manner in which the petitioner may be affected by the hearing, state why intervention or participation should be allowed, state any relief sought, and cite any law supporting intervention or participation. The petitioner shall serve copies of the petition on the parties at the April 22, 2010 hearing.
The HMO shall file with the Hearings and Appeals Docket Clerk of the Division of Insurance ("Docket Clerk") no later than 10:00 a.m. on April 20, 2010, a sequentially-numbered hearing statement ("the HMO's Statement"), consisting of the following:
(1) The HMO's Filing;
(2) A statement of the specific facts which form the basis for the HMO's request for hearing, including identification of each statutory or legal basis on which it relies;
(3) A copy of the April 1 Disapproval;
(4) A list of all products subject to the April 1 Disapproval;
(5) A statement of the specific errors the HMO asserts that the Commissioner has made, including a detailed statement of the matters in the April 1 Disapproval that it disputes and, for each issue, what products are involved;
(6) A statement of the relief the HMO seeks from the hearing;
(7) The identity of any person who will be the authorized representative of, or counsel for, the HMO in this proceeding;
(8) Other documents that it believes are relevant to the issues that it raises; and
(9) Certification of service of copies as specified below.
The HMO's Statement and any other information submitted to the Presiding Officers shall include both paper and electronic copies as follows:
(1) 5 paper copies, including one copy in an unbound format, addressed as follows:
Hearings and Appeals
Division of Insurance
1000 Washington Street
Boston, MA 02118-6200.
(2) an electronic copy in a WORD 1997-2003 version format transmitted to the Hearings and Appeals Docket Clerk at firstname.lastname@example.org.
(3) the docket number assigned to this matter must be included.
The HMO simultaneously shall serve a copy of the HMO's Statement and any other information submitted to the Presiding Officers in this matter on the Division and party intervenors, including the Attorney General, if she has intervened.
The HMO shall engage a qualified stenographer officially to record and transcribe all parts of the hearing. The HMO shall pay the stenographer's fees, including any fee for expedited transcripts, together with the cost of providing to the Docket Clerk an electronic version and four paper copies of the transcript, including a minuscript, one copy to the Division, and one copy to the Attorney General, if she has intervened.
Filed: April 15, 2010
Jean F. Farrington
Stephen M. Sumner
Susan L. Donegan