Document 90 : Docket No. 99-14 : Hearing Decision : Bureau of Insurance

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	)	MHA, INC. APPLICATION TO INTERVENE
	)
And	)
	)
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	)
	)
Consolidated Docket No. INS 99-14	)

Action Requested

Now comes MHA, Inc., on behalf of its members and by and through its counsel, to request that the Superintendent of the Bureau of Insurance grant MHA, Inc. intervenor status as a full party in this proceeding, pursuant to 5 M.R.S.A. § 9054(1), or in the alternative, as a full party pursuant to 5 M.R.S.A. § 9054(2) based upon the following:

MHA, Inc. Members Are Or May Be Substantially And Directly Affected By This Proceeding

And Have A Significant Interest In This Proceeding

MHA, Inc. ("MHA") is an association of Maine's hospitals and affiliated healthcare organizations representing 38 of Maine's community and specialty hospitals. Formed in 1937, the Augusta-based non-profit MHA is the primary advocate for hospitals in the Maine State Legislature, the U.S. Congress and state and federal regulatory agencies. MHA also provides educational services and serves as a clearinghouse for comprehensive information for its hospital members, lawmakers and the public. MHA is a leader in developing healthcare policy and works to stimulate public debate on important healthcare issues that affect all of Maine's citizens.

MHA members are or may be substantially and directly affected by the outcome of this proceeding and have an interest in this proceeding for at least three reasons. First, hospitals participated in the establishment of Blue Cross and Blue Shield of Maine ("BCBSME"), that was formed, in part, to increase access to hospital services. Hospitals have maintained a close relationship with BCBSME over the years as it grew to become the largest health insurer in the state, covering over 380,000 residents including MHA staff and their families as well as many of the employees of MHA members. This relationship began with the creation of BCBSME, and supports MHA’s request to intervene because the outcome of this proceeding could completely change the focus of the company that hospitals helped create and have since supported.

Second, according to its website and its 1998 Annual Report, BCBSME "was founded in 1938 with a mission of providing Maine citizens reasonable access to quality health care at an affordable price," and has "long worked with Maine’s hospital and physician communities to increase access to health care." MHA member hospitals have appreciated their collaborative relationship with BCBSME over the years, and are concerned that the conversion process could result in the loss of their partner in improving access to healthcare for Maine citizens. MHA believes that access to healthcare services is critical because lack of access negatively affects an individual’s overall health status and increases healthcare costs because preventive care and early diagnosis and treatment are more cost effective than crisis intervention.

Access to healthcare services, a priority goal for MHA members, may be substantially and negatively affected by the outcome of this proceeding. BCBSME’s commitment to improving access to quality healthcare, as described above, has been clearly reflected in their business practices. BCBSME has a long history of offering both individual and group coverage to populations that a for-profit or mutual company might well refuse to serve. Such refusal would be particularly worrisome to rural hospitals and their affiliates serving aging populations who have few, if any, other affordable options for coverage. In addition to insurance coverage, BCBSME has partnered with providers to increase access to quality healthcare programs, such as improving prenatal care, smoking cessation, increasing childhood immunization rates and supporting The AIDS Project. MHA members are concerned that the conversion process may result in decreased access to quality healthcare services for Maine residents. This would come at a time when MHA believes that access is Maine’s most urgent healthcare issue because more than 158,000 Maine residents lack health insurance, despite our relatively strong economy (1998 U.S. Census data).

Third, MHA members also have a number of essential contractual relationships with BCBSME that may be significantly affected by the conversion process. Every one of MHA’s 38 member hospitals has a Hospital Services Agreement with BCBSME, providing statewide access to hospital providers for BCBSME enrollees. In addition to those contracts, 19 MHA member hospitals form the complete hospital networks of BCBSME’s two community-centered health plan affiliates, the Maine Partners Health Plan and the Central Maine Partners Health Plan. BCBSME also serves as the Medicare Part A Intermediary for all 38 MHA member hospitals, as well as their affiliated home health agencies and skilled nursing facilities. BCBSME’s role as Fiscal Intermediary is critical to MHA members, not only for payment purposes, but also for the educational and provider support BCBSME offers to the hospitals. Together, these three types of business relationships with Maine’s largest healthcare insurer result in over 40 percent of MHA member total hospital payments.

The financial health of MHA members clearly depends upon these contractual relationships with BCBSME. In his November 12, 1999, Order Granting Applications to Intervene of the Maine Health Alliance, Maine Medical Association, Maine Council of Senior Citizens, Consumers for Affordable Health Care, Maine People’s Alliance, Maine Ambulatory Care Coalition and Central Maine Healthcare Corporation, the Superintendent of Insurance stated that "the contractual relationships between the providers represented by these organizations and BCBSME are so significant for these providers that the granting of intervention as of right is justified in this instance"(Doc. #54, page 2). MHA member hospitals and their affiliate organizations have equally significant contractual relationships with BCBSME. For the record, in accordance with the Superintendent’s Order on Coordination of Discovery by Intervenors, December 3, 1999 (Doc. #82) and the Maine Medical Association’s Letter Regarding Public Intervenors’ Proposal for Coordination of Discovery, November 19, 1999 (Doc. #63), MHA would hope to join the "provider" group for the coordination of discovery requests.

For the three reasons stated above, MHA members are or may be substantially and directly affected by this proceeding and have a significant interest in this proceeding. Therefore, MHA respectfully requests that the Superintendent of the Bureau of Insurance grant MHA intervenor status as a full party in this proceeding, pursuant to 5 M.R.S.A. § 9054(1), or in the alternative, as a full party pursuant to 5 M.R.S.A. § 9054(2).

DATED: December 9, 1999

_______________________

Sandra L. Parker, Esq.

Attorney for MHA, Inc.

150 Capitol Street

Augusta, Maine 04330

Phone: (207) 622-4794

Fax: (207) 622-3073

E-mail: sparker@themha.org

CERTIFICATE OF SERVICE

The undersigned hereby certifies that on December 9, 1999, a copy of MHA, Inc.’s Application to Intervene was served by United States mail, first class postage prepaid, on each of the persons listed below:

Robert S. Frank, Esq.

Harvey & Frank

Two City center

P.O. Box 126

Portland, Maine 04112

Judith Shaw Chamberlain, Esq.

Assistant Attorney General

Office of the Attorney General

6 State House Station

Augusta, Maine 04333-0006

William H. Laubenstein, Esq.

Assistant Attorney General

Office of the Attorney Genera

6 State House Station

Augusta, Maine 04333-0006

Gregory A. Brodek, Esq.

Duane, Morris & Heckscher, LLP

15 Columbia Street, 4^th Floor

Bangor, Maine 04401-6355

Gordon Smith, Esq.

Maine Medical Association

P.O. Box 190

Manchester, Maine 04351

Joseph Ditre, Esq.

Consumers for Affordable Health Care

P.O. Box 2490

Augusta, Maine 04338-2490

James B. Zimpritch, Esq.

Pierce Atwood

One Monument Square

Portland, Maine 04101

Michele M. Garvin, Esq.

Ropes & Gray

One International Place

Boston, Massachusetts 02110-2624

Robert Goldman

Maine Council of Senior Citizens

27 Bowery Beach Road

Cape Elizabeth, Maine 04107

John Dieffenbacher-Krall

Executive Director

Maine People’s Alliance

27 State Street, Suite 44

Bangor, Maine 04401

Bonnie Post