STATE OF MAINE
DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION
BUREAU OF INSURANCE

By letter dated November 15, 1999, the Superintendent of Insurance indicated he desires to consider the issue of whether or not an additional filing for a certificate of authority for an HMO line of business needs to be made. Further, the Superintendent required any party believing such a filing is required to file a position paper by November 23, 1999 giving the Applicants seven days from that date to respond to any filings made. The Superintendent stated he did not want to have replies to the Applicants’ response filed.

The Attorney General filed a Memorandum indicating his need for further information before adequately responding the legal question at hand. The provider intervenors have taken the position that no specific filing is required but Anthem must establish its ability to meet the requirements of the HMO Act in order to operate an HMO as a line of business. The provider group seeks to have the Notice of Hearing amended so that standard 26 reads: "whether, after the proposed change of control, Anthem Health Plan could satisfy the requirements for the issuance of a certificate of authority under the Maine HMO Act. (24-A M.R.S.A. §§4203-4204).

The consumer intervenors essentially support the position of the provider group, however, prefer to have a formal schedule for the filing of or reference to information on file supporting any assertion by Anthem that it has met the requirements of the HMO Act.

The Applicants filed a substantial document including a 24 page brief setting forth, in detail, their legal arguments supporting the view that no additional filing or inquiry into Anthem’s ability to meet the standards of the HMO Act is required. The Applicants argue that no separate filing is required and, to the extent there are additional requirements to be satisfied for the HMO line of business, those requirements will be adequately addressed through the review of the application pursuant to the other issues identified in the Notice of Hearing.

In stating that he did not want responses to the Applicants’ submission to be filed, the Superintendent did not anticipate that the Applicants might use this as an opportunity to address arguments that the Attorney General might have raised but did not. The majority of the Applicants’ brief is devoted to a discussion of why a separate filing should not be required, an issue the intervenors concede and the Attorney General chose not to address for lack of substantive information. To preclude the Attorney General from responding to the extensive legal argument put forth by the Applicants would serve no useful purpose. Rather, the Superintendent can benefit from any insights to be provided by the Attorney General.

At this point, the Superintendent believes the Attorney General has sufficient background to present a reasoned brief on this issue. No further delay will be permitted absent some emergency circumstance. The Attorney General has until 3:00 p.m., Wednesday, December 15, 1999, to file a response to the brief filed by the Applicants. The Superintendent does not see the need for further briefing from the other intervenors on this issue.

PER ORDER OF THE SUPERINTENDENT

DATED:                                                                                                                   
                                                                                ALESSANDRO A. IUPPA
                                                                                Superintendent of Insurance