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Details on Care New England’s Lawsuit

December 8, 2010

The Pulse has obtained a copy of Care New England’s (CNE) redacted complaint against Health Insurance Commissioner Chris Koller.  You can read the entire document here.

At issue are actually two things-

-CNE says Koller’s restrictions on contract negotiations are impairing their abilities to negotiate a fair contract with United Health Care (which expires December 31st)

-CNE is upset about an investigation Koller conducted into its contract with Blue Cross Blue Shield.  Koller completed a report on those negotiations  and planned to publicize the results.  Apparently, the report also nullified some portions of the contract.  CNE is suing to keep that from happening.

Care New England argues that-

1.  Office of the  Health Insurance Commissioner (OHIC) didn’t have the authority under Rhode Island law to impose restrictions on contract negotiations between hospitals and health insurers.

2.  OHIC doesn’t have the authority to interfere with contract negotiations, publicize information about those contracts, or nullify existing parts of current contracts  i.e. the Blue Cross Blue Shield contract report.

3.  OHIC released its contract restrictions without giving 30 days notice of the new rules, giving a concise summary of the proposals, and allowing for public comment.  CNE says this is a violation of Rhode Island’s Administrative Procedures Act.

Care New England says because of all of these points, Koller’s contract restrictions and his report on CNE and BCBS’s contract (called the “final order” in the lawsuit) are invalid and have no legal power.

The hearing on this issue is scheduled for December 15th- that’s 16 days before CNE and United Health Care’s contract expires.  As the lawsuit says, “time is of the essence.”

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