Code of Vermont Rules › Agency 80 - ADMINISTRATIVE AND ADVISORY AGENCIES › Sub-Agency 280 - GREEN MOUNTAIN CARE BOARD › Chapter 002 - RULE 2.000: HEALTH INSURANCE RATE REVIEW › Section 80 280 002 - RULE 2.000: HEALTH INSURANCE RATE REVIEW

Current through June, 2024
2.100 GENERAL PROVISIONS
Section 2.101 Purpose
The Green Mountain Care Board shall review requests for health
				insurance rates pursuant to
				18 V.S.A. §
												9375 and
				8 V.S.A.
				§ 4062, taking into consideration the requirements in the underlying
				statutes, changes in health care delivery, changes in payment methods and
				amounts, and other issues at the discretion of the Board. This rule sets forth
				the process by which the Green Mountain Care Board will review health insurance
				rate requests.
Section
			 2.102 Authority
This rule is adopted pursuant to
				8 V.S.A. §
												4062,
				18
				V.S.A. § 9375, and 18 V.S.A. § 9380.
Section 2.103 Definitions
(a) "Advocate" means the Office of the Health
			 Care Advocate established by 18 V.S.A. chapter 229.
(b) "Applicant" means the Person filing a
			 rate request.
(c) "Board" means the
			 Green Mountain Care Board.
(d)
			 "Chair" means the Chair of the Green Mountain Care Board or a designee
			 appointed by the Chair.
(e)
			 "Commissioner" means the Commissioner of the Department of Financial
			 Regulation.
(f) "Confidentiality
			 Order" means the Confidentiality Order issued by the Board on March 13, 2013
			 and includes any subsequent amendments or modifications issued by the
			 Board.
(g) "Department" means the
			 Department of Financial Regulation.
(h) "Party" means each Person designated as a
			 party (including an interested party) in Section 2.105 of this rule. Each Party
			 shall have the opportunity to present evidence and argument and respond on all
			 issues involved in the rate review for which that Person is a Party.
(i) "Person" means any natural person,
			 partnership, corporation, association, governmental subdivision, public agency,
			 or other similar legal entity.
Section 2.104 Applicability
(a) This rule shall be applicable to rate
			 requests requiring Board action pursuant to
			 18 V.S.A. §
												9375(b)(6) and
			 8 V.S.A.
			 § 4062 and received by the Board on or after January 1, 2014.
(b) The Board shall commence its review of
			 rate requests upon receipt of an applicant's rate filing submitted via the
			 System for Electronic Rate and Form Filing (SERFF).
(c) The Applicant shall bear the burden to
			 justify the rate request.
Section
			 2.105 Party Status
(a) The
			 Applicant shall be a Party.
(b) The
			 Advocate may participate as a Party by filing a notice of appearance pursuant
			 to section 2.303 of this rule.
(c)
			 Interested Party Status.
(1) The Board shall
			 grant interested party status to a Person who is not a Party pursuant to
			 subsections (a) and (b) and who demonstrates that he or she will be
			 substantially and directly affected by the rate request under review.
(2) A general interest in a proceeding shall
			 not be sufficient to attain interested party status. For example, the fact that
			 a Person is covered by the policy under review, or a Person is generally
			 concerned with the health care system, does not in itself qualify the Person as
			 an interested party.
(3) An
			 application for interested party status must be in writing and must be filed
			 with the Board and served on all parties no later than fifteen days after the
			 date on which the Board posts the rate request on its website. The application
			 must provide a detailed statement of the requestor's substantial and direct
			 interest(s) in the proceeding and explain how the requestor's interest(s)
			 specifically relate to the rate request under consideration. Failure to
			 sufficiently explain why interested party status should be granted will result
			 in a denial of the application. Any Party may respond in writing to an
			 application within five (5) days of service of the application. The Board shall
			 rule on the application within ten (10) days from receipt. If the Board denies
			 interested party status, the Board shall inform the requestor that he or she
			 continues to have the right to submit public comments and/or comment at any
			 hearing(s) and the Board may grant such Person amicus curiae status if it finds
			 that the application satisfies subsection 2.105(d) of this rule. A Person
			 granted interested party status shall be deemed to have entered a timely notice
			 of appearance.
(4) An interested
			 party:
(i) shall be copied on all materials
			 in the record, except that confidential information will only be disclosed in
			 accordance with section 2.305 of this rule to a Party who has complied with the
			 Confidentiality Order, including by filing the Confidentiality Acknowledgment
			 required by the Confidentiality Order;
(ii) may participate as a Party in the review
			 process set forth in this rule; and
(iii) may appeal the Board's decision or
			 other ruling eligible for appeal to the Vermont Supreme Court within thirty
			 (30) days of the date of the Board's decision or ruling.
(d) Amicus curiae status. The
			 Board may grant amicus curiae status upon a showing that the Person requesting
			 such status will be able to render material assistance to the Board by
			 providing nonduplicative evidence relevant to the Board's review.
(1) An application for amicus curiae status
			 must be in writing and must be filed with the Board and served on all Parties
			 no later than fifteen (15) days after the date on which the Board posts the
			 rate request on its website. The application must provide a detailed statement
			 showing that the requestor will provide nonduplicative evidence relevant to the
			 rate request under consideration. Failure to sufficiently explain why amicus
			 curiae status should be granted will result in a denial of the application. Any
			 Party may respond in writing to an application within five (5) days of service
			 of the application. The Board shall rule on the application within ten (10)
			 days from receipt.
(2) An amicus
			 curiae shall not be considered a Party, but shall be copied on all materials in
			 the record in the same manner as a Party, except that confidential information
			 within the meaning of the Confidentiality Order shall not be shared with amicus
			 curiae except as provided in subsection 2.305(c) of this rule.
(3) An amicus curiae shall follow the
			 procedures set forth in this rule in order to introduce information into the
			 record. Materials submitted by amicus curiae shall be copied to all Parties by
			 the amicus.
Section
			 2.106 Time
(a) Unless otherwise
			 specified, "day(s)" means calendar day(s).
(b) In computing any time period established
			 or allowed by this rule or by order of the Board or Chair, the day of the act
			 or event from which the designated time period begins to run shall not be
			 included, nor shall weekends or federal or state holidays be included in the
			 calculation if the last day in the time period falls on such weekend or
			 holiday.