Document 478 : Docket No. 99-14 : Hearing Decision : Bureau of Insurance

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

)

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)

)

ANTHEM INSURANCE COMPANIES, INC.’S FIRST SUPPLEMENT TO RESPONSE TO FIRST DISCOVERY REQUEST OF THE PROVIDER INTERVENOR GROUP

March 1, 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 submits the First Supplement to its Response 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.

8. 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:
CONFIDENTIAL RESPONSE REDACTED.

19. 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:
Pages 18-19 of the Form A describe the management structure that Anthem anticipates for the to-be-formed Anthem Health Plans of Maine, Inc. The decision-making responsibilities for local, regional and corporate management are also reflected therein. Please see also Anthem’s First Supplement to its Response to the Consumer Intervenors’ Second Request, question no. 28, for additional information concerning the local decision-making responsibility afforded to subsidiaries in making individual medical care decisions.

22. 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:
Anthem anticipates continuation of local medical advisory and quality committees which currently serve as vehicles for engaging Maine physicians in the design and oversight of credentialing, medical management and quality improvement activities. Determinations of medical necessity and the selection of criteria which underlie these determinations will continue to be made locally with the input of Maine physicians. Medical policies related to coverage decisions will be developed based on national evidence (as has been the practice to date in Maine), and reviewed within Maine’s quality committee structures.

34. 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:

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 does not have a corporate mandate on the number of times subscribers may self-refer to reproductive health providers. Decisions such as this will be made at the local level by Anthem Health Plans of Maine, Inc.’s local administrative and medical teams. BCBSME’s current practice, in compliance with state law, is to permit self-referral for one annual OB/GYN visit. For all other visits, BCBSME requires a referral. Anthem does not anticipate deviating from this practice, but in any event, the decision to continue or modify BCBSME’s current practice will be made locally.

DATED: March 1, 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 March 1, 2000 a copy of the Non-Confidential Version of Anthem Insurance Companies, Inc.’s First Supplement to 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, 4^th 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.

John Doyle, Jr., Esq.

Attorneys for MHA, Inc.

150 Capitol Street

Augusta, Maine 04330

e-mail: sparker@themha.org

jdoyle@preti.com

(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)

DATED: March 1, 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