NON-CONFIDENTIAL
STATE OF MAINE
DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION
BUREAU OF INSURANCE
| IN RE: APPLICATION OF ASSOCIATED HOSPITAL
SERVICE OF MAINE, d/b/a BLUE CROSS AND BLUE SHIELD OF MAINE, TO CONVERT TO A STOCK INSURER
AND VOLUNTARILY LIQUIDATE AND DISSOLVE |
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IN RE: APPLICATION OF ANTHEM
HEALTH PLAN OF MAINE, INC.,
TO ACQUIRE THE ASSETS OF ASSOCIATED HOSPITAL SERVICE OF MAINE, d/b/a BLUE CROSS AND BLUE
SHIELD OF MAINE, AND RELATED TRANSACTIONS Docket NO. INS 99-14 (CONSOLIDATED) |
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ANTHEM INSURANCE COMPANIES,
INC.’S RESPONSE TO FIRST DISCOVERY REQUEST OF THE PROVIDER INTERVENOR GROUP
February 22, 2000 |
NON-CONFIDENTIAL
Applicants, Anthem Insurance Companies, Inc., on behalf of its subsidiary to be formed,
Anthem Health Plans of Maine, Inc., d/b/a Anthem Blue Cross and Blue Shield (collectively
"Anthem"), hereby responds to the First Discovery Request of the Provider
Intervenor Group, dated February 4, 2000, as follows:
The following responses by Anthem are subject to the objections filed by Anthem on
February 12, 2000. To the extent that any additional responsive documents are located in
the future, Anthem reserves its rights to object to producing such documents to the extent
covered by the attorney-client and or work product privileges.
- Please provide copies of the forms of provider agreements that Anthem has utilized in
contracting with physician, hospital and other providers in the States of New Hampshire,
Colorado, Nevada, Connecticut, Ohio, Kentucky and Indiana.
Response: |
Anthem incorporates by reference its
objections to this request filed on February 14, 2000. Subject to and without waiving
these objections, Anthem responds as follows: Given the recent acquisitions in New
Hampshire, Colorado, and Nevada, provider agreements currently used in those states are
irrelevant. Forms of provider agreements for the states of Connecticut, Kentucky, Indiana
and Ohio, AN-8458 to AN-9236, will be distributed according to the service list referenced
in the filing document. |
- Please provide copies of any and all Anthem executive or management policies,
procedures, standards, directives or other determinations concerning the provisions, terms
and conditions of provider agreements to be entered into by Anthem or any Anthem
subsidiaries or affiliates with physician, hospital or other providers.
Response:
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Anthem incorporates by reference its
objections to this request filed on February 14, 2000. Subject to and without waiving
these objections, Anthem responds as follows: Please see Anthem’s responses to
questions 1 and 9. There are no general corporate mandates or directives concerning the
provisions, terms or conditions of all provider agreements entered into by Anthem
subsidiaries. With the proposed purchase of substantially all of the assets of BCBSME,
Anthem will continue to honor the provider agreements executed by BCBSME for the duration
of the respective contracts. When the terms of the agreements expire, Anthem’s
regional management will evaluate the substance of the agreements. Although Anthem
currently has no "corporate-mandated standards" for provider contracts, Anthem
anticipates that its East Region integration team may develop certain as yet unidentified
consistent standards for regional provider contracts.
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- Please advise whether, to what extent and for what period of time, Anthem will honor
existing provider agreements with BCBSME and will continue to utilize the forms of such
provider agreements without material change.
Response: |
Please see Anthem’s response to question
no. 2. |
- Please advise whether there are included in any Anthem provider agreements in any state
any so-called "all products clause" or any "most favored customer"
clause.
Response: |
There are "most favored customer"
clauses in several of Anthem’s contracts with hospital/institutional providers,
however, Anthem has not sought to include these, or similar requirements, for the
professional providers. In addition, Anthem requests physicians who participate in HMOs to
participate in indemnity products as well. |
- Please identify and describe the Anthem policies, programs or practices in any state for
the payment of provider fees or charges, provider reimbursement or provider compensation.
Response: |
CONFIDENTIAL RESPONSE REDACTED. |
- Please identify and describe any downstream risk-sharing arrangements or programs,
including capitation, included in any Anthem provider agreement in any state.
Response:
|
Please see Anthem’s responses to question
numbers 1 and 2. Anthem participates in a variety of risk-sharing arrangements, all of
which comply with the prevailing laws and regulations of the particular state in which the
arrangement or program is in place. Although Anthem has no specific plans in this regard,
to the extent Anthem Health Plans of Maine, Inc. will enter into such arrangements in the
future, those arrangements will comply with Maine law. |
- Please advise whether Anthem will utilize in Maine any forms of provider agreements for
osteopathic physicians that are different from the forms of provider agreements for other
physicians. Please advise whether Anthem shall seek to impose any special provisions,
limitations or restrictions on the delivery of osteopathic manipulation services.
Response: |
BCBSME currently has a single standard for
credentialling and contracting with allopathic and osteopathic physicians. Anthem does not
anticipate making any changes to that practice, nor does it anticipate imposing any new or
special restrictions or limitations on the delivery of osteopathic manipulation services. |
- Please identify and describe in detail and with specificity the management information
systems support made available by Anthem and delivered to providers sharing or assuming
any "downstream" risk, including reports provided and data made available to
providers. Please provide copies of report formats and schedules for the delivery of
reports. Please identify and describe any provider rights to access, download and retain
Anthem data or information relevant to a respective provider’s productivity,
utilization or other performance or relevant to any risk pool in which a respective
provider is a participant.
Response:
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Anthem incorporates by reference its
objections to this request filed on February 14, 2000. Subject to and without waiving
these objections, Anthem responds as follows: Anthem is in the process of preparing the
responsive information and will file it as soon as it becomes available . |
- Please identify and describe and please provide copies of any policies, protocols,
procedures or any documents that identify or describe the extent of discretion of a local
Anthem provider agreement negotiator to modify or amend any provision of an Anthem form of
provider agreement.
Response:
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Please see Anthem’s response to question
no. 2. In each of the geographic regions in which Anthem operates, there are provider
contract representatives and general standard agreements that form the basis for
negotiating contracts with providers. The provider contracting representatives have the
discretion to negotiate contract terms in accordance with local conditions. |
- Please advise and describe with specificity the extent to which policies and standards
for the terms and conditions of Anthem provider agreements are or will be made at the
regional or national levels, rather than at the local, Maine level.
Response: |
Please see Anthem’s response to question
no. 2. |
- Please provide copies of any of the following to be used by Anthem Blue Cross-Blue
Shield of Maine upon and after closing of this transaction:
- utilization review plans, standards or protocols;
- quality improvement plans, standards or protocols;
- credentialing plans, standards or protocols.
Response:
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Please see Anthem Health Plans of Maine,
Inc.’s Application for Certificate of Authority to Operate a Health Maintenance
Organization and the confidential Quality Improvement Program filed therewith. As reported
in that filing, Anthem intends to utilize BCBSME’s currently existing Quality
Improvement Program and Standards, Access Plan and provider networks, provider
credentialing standards, utilization review standards, grievance and appeals procedures
and benefits plans. Anthem has also agreed in the Asset Purchase Agreement to exercise
commercially reasonable efforts to maintain NCQA accreditation for Anthem BCBS of Maine
for at least two years following the acquisition. |
- Please identify the dollar amounts of Anthem capital resources that will be contributed
to Anthem Blue Cross-Blue Shield of Maine by the time of closing of this transaction and
that will be available and accessible to Anthem Blue Cross-Blue Shield during the three
(12) years immediately following the closing of this transaction.
Response:
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Please see Anthem’s Second Supplement to
the Response to the Superintendent’s Second Discovery Request, question no. 29. The
amount of capital to be infused into Anthem Blue Cross and Blue Shield of Maine has not
been determined. Among the factors taken into account when making such a determination are
the financial performance of Associated Hospital Services of Maine through closing and the
expected financial performance of Anthem Blue Cross and Blue Shield. |
- Please advise of any standards to be satisfied or any authorizations that will be
required prior to any Anthem contribution, or additional contribution, to the capital of
Anthem Blue Cross-Blue Shield of Maine.
Response:
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Under Indiana law, an insurance company may
not make a capital contribution to a subsidiary in an amount that exceeds the lesser of
(a) 3% of the parent’s admitted assets or (b) 25% of the parent’s surplus,
unless prior approval is obtained from the Indiana Department of Insurance. In addition,
contributions of unusual size are submitted to Anthem’s Board of Directors for
approval. |
- Please provide any and all documents and information relevant to the design, planning,
organization, startup and operations of the "East Region," including any
documents and information concerning the date of commencement of operations of the East
Region, and the scope, nature and extent of the administrative, management or other
support to be provided by the "East Region" to Anthem Blue Cross-Blue Shield of
Maine and Maine providers.
Response:
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Anthem incorporates by reference its
objections to this request filed on February 14, 2000. In response to question nos. 1, 7
& 13 of the First Discovery Request of the Attorney General, Anthem provided its
integration plans for the East Region. To the extent the request seeks information beyond
that already provided in response to the Attorney General’s discovery requests, the
request seeks information that is irrelevant to this proceeding; it is overly broad; and
it would be overly burdensome to produce and/or obtain the requested information. |
- Please advise whether Anthem will include on its "national Board of Directors"
any representative from the State of Maine, and please identify the criteria for and
method of election/selection of any such person.
Response:
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As Anthem stated in the Initial Consolidated
Filing, it will use its reasonable best efforts to cause a candidate designated by the
BCBSME Board of Directors, who is acceptable to Anthem’s Board of Directors, to be
elected or appointed to Anthem’s Board of Directors for a term of not less than two
(2) years. |
- Please advise whether and to what extent provisions shall be made to include providers
on the Board of Directors of Blue Cross-Blue Shield of Maine.
Response:
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Anthem interprets this question as asking
whether there are provisions for Anthem to include providers on the Board of Directors of
the to-be-formed Anthem Health Plans of Maine, Inc. With that understanding, there are no
such provisions. In the Initial Consolidated Filing, Anthem listed the individuals that
will be members of the Anthem Health Plans of Maine Board if this transaction is approved. |
- Will the Maine-based senior medical officer of Anthem Blue Cross-Blue Shield of Maine be
a physician licensed to practice medicine in the State of Maine?
Response:
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Anthem’s practice in other states has
been that the senior physician is licensed to practice medicine in the applicable state.
Although Anthem has not yet identified the "Maine-based senior medical officer"
for the to-be-formed Anthem Health Plans of Maine, Inc., Anthem does not anticipate
deviating in Maine from its past practice in other states. |
- How will Anthem change the current BCBSME product line? Will the company continue to
offer both managed care and indemnity products? Will Anthem maintain BCBSME’s
position as the primary provider of individual coverage in the State of Maine?
Response:
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Please see Anthem’s Response to the
Attorney General’s First Discovery Request, question no. 13. Anthem offers a broad
range of indemnity and managed care products to individual and group purchasers in each of
the primary states in which it serves Blue Cross and Blue Shield members. We expect to
offer the similar range of product choices to individual and group members in Maine. |
- How will Anthem structure its senior management in Maine? Will medical and
administrative decisions continue to be made locally in the State of Maine?
Response: |
Anthem is in the process of preparing the
responsive information and will file it as soon as it becomes available. |
- Does Anthem plan any reduction in the staffing of BCBSME? If so, please identify
positions to be reduced or eliminated and the job descriptions and functions of each such
position.
Response:
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Please see Anthem’s Response to the
Second Discovery Request of the Superintendent, question no. 16. See also Section
5.12 of the Asset Purchase Agreement and Applicants’ Form A at 5-6, explaining
Anthem’s agreements regarding post-closing employment levels. |
- How will Anthem administer prescription drug and behavioral health benefits in Maine?
Will Maine providers be asked to take on or share any financial risks arising out of or
related to pharmacy benefits?
Response: |
With the proposed purchase of substantially
all of the assets of BCBSME, Anthem will continue to honor the prescription drug and
behavioral health benefits agreements executed by BCBSME for the duration of the
respective contracts. As reflected in the integration team summaries already provided, see,
e.g., AN-02074, Anthem’s intention is to transition to Anthem Prescription
Management as soon as possible, but over a sufficient period of time to avoid any member
disruption associated with drug vendor changes. Anthem has no specific plans to ask Maine
providers to take on or share any financial risks arising out of or related to pharmacy
benefits; however, Anthem plans to revisit this issue when contracts are renegotiated. |
- How will Anthem involve Maine physicians in the development of medical policy; in
coverage decisions, particularly the determination of medical necessity; in the
establishment of credentialing standards; and in the quality management and utilization
review activities?
Response:
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Anthem is in the process of preparing the
responsive information and will file it as soon as it becomes available. |
- Please describe in detail any and all Anthem policies, programs, directives or other
determinations concerning community benefit programs, such as health screenings, free
immunizations and other such community benefit programs, to be pursued in the State of
Maine. Please provide a copy of any such policies, programs, directives or other
determinations. Please explain whether and to what extent any such community benefit
programs to be provided by Anthem in the State of Maine will differ in scope or quality
from the community benefit programs that have been provided by BCBSME. Please advise of
the amounts of funds that will be made available for any such community benefit programs
annually during the first three years of operation of Anthem Blue Cross-Blue Shield of
Maine.
Response:
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Anthem supports community programs in each
state in which it serves Blue Cross and Blue Shield members. Anthem establishes general
policy guidelines for local support, which are then applied at the regional, state and
local level in response to specific community needs. Anthem’s guidelines require that
community support initiatives focus on the development of "healthy minds, healthy
bodies and healthy communities." Local and regional management establishes funding
levels for local community support programs and approves the direction of their
distribution within the above guidelines. The Asset Purchase Agreement requires that the
level of community support programs in Maine be maintained at a level equal to or greater
than $500,000 for the first two years after the close of the transaction. |
- Please provide information about Anthem’s relationship with Federally Qualified
Health Centers (FQHCs) in each state in which it operates, including, but not limited to,
all contracts it has in place with Federally Qualified Health Centers and/or their
clinicians and copies of provider handbooks provided to enrollees in each state which show
how FQHCs and/or their clinicians are identified. We are particularly interested in
knowing if in all states Anthem contracts directly with the FQHC or if they only contract
with their clinicians and Anthem’s practices on listing both the health center and
their providers in provider handbooks.
Response:
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Anthem incorporates by reference its
objections to this request filed on February 14, 2000. Subject to and without waiving
these objections, Anthem responds as follows: The only Anthem subsidiary that deals with
Medicaid and thus, tangentially, FQHCs, is Anthem BCBS of Connecticut. Anthem does not
contract directly with FQHCs. Anthem, however, does contract with providers who practice
in FQHCs. Anthem does not have separate reimbursement policies for nurse practitioners and
physician assistants practicing in FQHCs. Reimbursement policies for all providers are
applied uniformly. In addition, providers/clinicians in Anthem’s provider directory
are not specifically identified as FQHC providers/clinicians. |
- Please provide information about any limitations or special conditions Anthem places on
FQHCs, including whether it contracts with FQHCs for all services they provide and if it
requires accreditation or licensing of these entities.
Response:
|
Anthem incorporates by reference its
objections to this request filed on February 14, 2000. Subject to and without waiving
these objections, Anthem responds as follows: Please see Anthem’s response to
question no. 24. |
- Please provide information that demonstrates Anthem’s reimbursement policies for
nurse practitioners and physician assistants practicing in FQHC. We are particularly
interested in determining whether Anthem provides a lower reimbursement for nurse
practitioner and physician assistant services in FQHCs than they do for similar physician
services in those settings.
Response:
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Anthem incorporates by reference its
objections to this request filed on February 14, 2000. Subject to and without waiving
these objections, Anthem responds as follows: Please see Anthem’s response to
question no. 24. |
- Please provide documentation relative to the number of FQHCs in each state with whom
Anthem directly contracts.
Response:
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Anthem incorporates by reference its
objections to this request filed on February 14, 2000. Subject to and without waiving
these objections, Anthem responds as follows: Please see Anthem’s response to
question no. 24.
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- Please provide documentation that details Anthem’s future plans regarding indemnity
coverage in Maine. Include documentation that details Anthem’s existing and five-year
history regarding indemnity coverage in all other states in which Anthem is present.
Response:
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Anthem incorporates by reference its
objections to this request filed on February 14, 2000. Subject to and without waiving
these objections, Anthem responds as follows: Please see Anthem’s response to
question no. 18 . |
- Please provide documentation that Anthem accepts the Federal Tort Claims Act coverage in
lieu of medical malpractice insurance in all states in which it provides coverage.
Response:
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Anthem incorporates by reference its
objections to this request filed on February 14, 2000. Subject to and without waiving
these objections, Anthem responds as follows: No documentation exists. In addition, in
Indiana, for example, Anthem does not accept Federal Tort Claims Act coverage since the
state has a risk pool for medical malpractice claims. |
- Please describe how Anthem will outline reproductive health services to its subscribers.
Response:
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Anthem incorporates by reference its
objections to this request filed on February 14, 2000. Subject to and without waiving
these objections, Anthem responds as follows: Anthem will honor reproductive health care
services coverage currently offered by BCBSME. Presently, BCBSME has contracts with family
planning programs. Anthem has no plans to terminate involvement with those programs. |
- What will Anthem include as services for reproductive health care?
Response:
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Anthem incorporates by reference its
objections to this request filed on February 14, 2000. Subject to and without waiving
these objections, Anthem responds as follows: Please see Anthem’s response to
question no. 30. |
- Will Anthem contract with family planning programs for all services each program
provides, such as colposcopy, endometrial biopsies? Please explain your rationale for your
answer.
Response:
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Anthem incorporates by reference its
objections to this request filed on February 14, 2000. Subject to and without waiving
these objections, Anthem responds as follows: Please see Anthem’s response to
question no. 30. |
- Please provide documentation that details Anthem’s future plans regarding
contracting with nurse practitioners.
Response:
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Anthem incorporates by reference its
objections to this request filed on February 14, 2000. Subject to and without waiving
these objections, Anthem responds as follows: No documentation exists. Anthem will
comply with prevailing laws and regulations in contracting with nurse practitioners. |
- Will Anthem allow subscribers to self-refer to reproductive health providers (including
nurse practitioners) beyond the state mandated statute of one annual visit per year?
Please explain your rationale for your answer.
Response:
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Anthem incorporates by reference its
objections to this request filed on February 14, 2000. Subject to and without waiving
these objections, Anthem responds as follows: Anthem is in the process of preparing the
responsive information and will file it as soon as it becomes available. |
DATED: February 22, 2000
_____________________________
James B. Zimpritch, Esq.
Jeffrey M. White, Esq.
Catherine R. Connors, Esq.
PIERCE ATWOOD
One Monument Square
Portland, Maine 04101
(207) 791-1100
Attorneys for Anthem Insurance Companies, Inc
CERTIFICATE OF SERVICE
The undersigned hereby certifies that on February 22, 2000 a copy of the
Non-Confidential Version of Anthem Insurance Companies, Inc.’s Response to the First
Discovery Request of the Provider Intervenor Group was served by United States mail, first
class postage prepaid, email, or, where indicated, by hand delivery, on each of the
persons listed below.
Robert S. Frank, Esq.
Harvey & Frank
Two City Center
P.O. Box 126
Portland, Maine 04112
e-mail: frank@harveyfrank.com
(Blue Cross/Blue Shield of Maine)
Judith Chamberlain, Esq.
State of Maine
Department of the Attorney General
6 State House Station
Augusta, Maine 04333-0006
e-mail: judy.chamberlain@state.me.us
(Bureau of Insurance)
William H. Laubenstein, Esq.
State of Maine
Department of the Attorney General
6 State House Station
Augusta, Maine 04333-0006
e-mail: bill.laubenstein@state.me.us
(Office of the Attorney General)
Gregory A. Brodek, Esq.
Duane, Morris & Heckscher, LLP
15 Columbia Street, 4th Floor
Bangor, Maine 04401-6355
e-mail: gabrodek@duanemorris.com
(Maine Health Alliance)
Joseph P. Ditre, Esq.
Consumer Health Law Program
One Weston Court, Level One
P.O. Box 2490
Augusta, Maine 04338-2490
e-mail: jditre@mainecahc.org
(Consumers for Affordable Health Care Foundation/Coalition)
Michele M. Garvin, Esq.
Ropes & Gray
One International Place
Boston, Massachusetts 02110-2624
e-mail: Mgarvin@Ropesgray.com
(Central Maine Healthcare Corporation; Central Maine Partners Health Plan)
Robert I. Goldman
Maine Council of Senior Citizens
27 Bowery Beach Road
Cape Elizabeth, Maine 04107
e-mail: Rgoldma1@maine.rr.com
(Maine Council of Senior Citizens)
Bonnie Post
Executive Director of the Maine Ambulatory Care Coalition
P.O. Box 390
Manchester, Maine 04351
e-mail: bdpmacc@mint.net
(Sacopee Valley Health Center, Regional Medical Center at Lubec, Eastport Health Care,
Inc., and the Maine Ambulatory Care Coalition)
John Dieffenbacher-Krall
Executive Director
Maine People’s Alliance
192 State Street
Portland, Maine 04101
e-mail: MPA@gwi.net
(Maine People’s Alliance)
Gordon H. Smith, Esq.
Maine Medical Association
30 Association Drive
P.O. Box 190
Manchester, Maine 04351
e-mail: gsmith@ctel.net
(Thomas D. Hayward, M.D.,
Maroulla S. Gleaton, M.D.,
And the Maine Medical Association)
Donald E. Quigley, Esq.
General Counsel
465 Congress Street, Suite 600
Portland, Maine 04101-3537
e-mail: quigld@mail.mmc.org
(Maine Medical Center)
Sandra L. Parker, Esq.
Attorney for MHA, Inc.
150 Capitol Street
Augusta, Maine 04330
e-mail: sparker@themha.org
(MHA, Inc.)
Kellie P. Miller, M.S.
Executive Director
Maine Osteopathic Association
693 Western Avenue
Manchester, Maine 04351
e-mail: meosteo@mint.net
(Maine Osteopathic Association)
Edward Miller
Executive Director
American Lung Association of Maine
122 State Street
Augusta, Maine 04330
e-mail: emiller@mainelung.org
(American Lung Association of Maine)
DATED: February 22, 2000
_____________________________
James B. Zimpritch, Esq.
Jeffrey M. White, Esq.
Catherine R. Connors, Esq.
PIERCE ATWOOD
One Monument Square
Portland, Maine 04101
(207) 791-1100
Attorneys for Anthem Insurance Companies, Inc.
Last Updated:
August 22, 2012
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