Care New England Health System v. The Rhode Island Office of Health Insurance Commissioner
Decision Date | 28 September 2011 |
Docket Number | C.A. PC 10-6984 |
Court | Rhode Island Superior Court |
Parties | CARE NEW ENGLAND HEALTH SYSTEM; WOMEN & INFANTS HOSPITAL OF RHODE ISLAND; BUTLER HOSPITAL, KENT COUNTY MEMORIAL HOSPITAL; and KENT COUNTY VISITING NURSE ASSOCIATION d/b/a VNA OF CARE NEW ENGLAND v. THE RHODE ISLAND OFFICE OF THE HEALTH INSURANCE COMMISSIONER; CHRISTOPHER F. KOLLER in his capacity as HEALTH INSURANCE COMMISSIONER; UNITED HEALTHCARE OF NEW ENGLAND, INC., UNITED BEHAVIORAL HEALTH, INC.; and BLUE CROSS & BLUE SHIELD OF RHODE ISLAND |
DECISION
Before the Court is Plaintiffs Care New England Health System, Women & Infants Hospital of Rhode Island, Butler Hospital, Kent County Memorial Hospital, and Kent County Visiting Nurse Association d/b/a VNA of Care New England's (collectively, CNE) Partial Motion for Summary Judgment.1[] Also before the Court is Defendants The Rhode Island Office of the Health Commission and Health Insurance Commissioner Christopher F. Koller's (Commissioner Koller) (collectively, OHIC) Motion for Summary Judgment. The instant matter arises out of OHIC's November 16, 2010 Final Order (OHIC-2010-5) (Final Order)—following an examination pursuant to G.L. 1956 §§ 27-13.1-1, et seq. (Examinations Statute)—which abrogated certain provisions contained within contracts between CNE and Blue Cross and Blue Shield of Rhode Island (Blue Cross) and imposed upon Blue Cross an administrative penalty of $5, 000.
As a preface, the Court will provide a brief survey of the legislative and statutory terrain encompassing OHIC and Blue Cross as it relates to the instant matter.
Blue Cross is a nonprofit hospital and medical service corporation incorporated pursuant to title 27, chapters 19, 19.2, and 20 of our General Laws. See Blue Cross/Blue Shield of R.I v. State Dep't of Bus. Regulation, No. 04-5769, 2005 WL 1530449, at * 7 (R.I. Super. June 23, 2005) (Silverstein J.); see also Blue Cross and Blue Shield of R.I. v Caldarone, 520 A.2d 969, 970 (R.I. 1987). Within the confines of this statutory scheme, Blue Cross is generally authorized to establish, maintain, and operate health plans for the purpose of providing medical and hospital services to its subscribers. See generally, §§ 27-19-1(3); 20-1(4), (5), and (6).
In 2004, following a public controversy over the management of Blue Cross, the General Assembly enacted The Rhode Island Health Care Reform Act of 2004 – Health Insurance Oversight (the Act), G.L. 1956 §§ 42-14.5-1 through 42-14.5-3, creating OHIC within the Rhode Island Department of Business Regulation (DBR). See Blue Cross and Blue Shield of R.I. v. McConaghy, No. PC 04-6806, 2005 WL 1633707, at *1 (R.I. Super. 2005). Under the Act, OHIC was endowed with specific regulatory powers and duties related to the health insurance industry in Rhode Island. Id.
In connection therewith, the General Assembly made the following legislative findings:
The General Assembly endowed the health insurance commissioner with the following powers and duties:
The health insurance commissioner was authorized to discharge these powers and duties in order to:
"(a) Guard the solvency of health insurers; (b) Protect the interests of consumers; (c) Encourage fair treatment of health care providers; (d) Encourage policies and developments that improve the quality and efficiency of health care service delivery and outcomes; and (e) View the health care system as a comprehensive entity and encourage and direct insurers towards policies that advance the welfare of the public through overall efficiency, improved health care quality, and appropriate access." Sec. 42-14.5-2.
Also in 2004, the General Assembly enacted chapter 19.2 of title 27, entitled Nonprofit Hospital and Medical Corporations, which specifically addressed the administration of Blue Cross. In drafting the legislation, the General Assembly expressly found that it was in the best interest of the residents of Rhode Island:
For that reason, the General Assembly charged Blue Cross with the following mission statement:
In accordance with that mission, the General Assembly required Blue Cross to:
CNE is a Rhode Island healthcare system comprised of Women & Infants Hospital of Rhode Island, Butler Hospital, Kent County Memorial Hospital, and VNA of Care New England. See Delmonico Aff. ¶ 3. Blue Cross is a taxable nonprofit corporation...
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