Oregon Revised Statutes Chapter 743 § 743.019 — Procedure for review of proposed rates for health benefit plans; rules

Procedure for review of proposed rates for health benefit plans; rules. (1) When an insurer files a schedule or table of premium rates for individual or small employer health benefit plans under ORS 743.018, the Department of Consumer and Business Services shall open a 30-day public comment period on the rate filing that begins on the date the insurer files the schedule or table of premium rates. The department shall post all of the comments received to the department’s website without delay. (2) After the close of the public comment period described in subsection (1) of this section, the department shall issue a proposed order to approve, disapprove or modify a rate filing. The department shall notify the insurer of, and make available to the public, the proposed order, including: (a) An explanation of the findings and rationale that are the basis for the proposed order; and (b) Any actuarial or other analyses, calculations or evaluations relied upon by the department in arriving at the proposed order. (3) The department shall provide the insurer or any person adversely affected or aggrieved by the proposed order the opportunity to meet with the department to discuss and respond to the proposed order. However, an insurer or other person may not substitute new facts or data for the facts or data submitted by the insurer in the filing. The meeting shall: (a) Include a department employee who reviewed the rate filing; and (b) Comply with the requirements of ORS 192.610 to 192.705. (4)(a) The department shall issue a final order, no later than 30 days after the department issues a proposed order under subsection (2) of this section, to approve, disapprove or modify the rate filing based on the meeting held under subsection (3) of this section. (b) In issuing the final order, the department may not consider new facts or data that are offered as a substitute for the facts or data submitted by the insurer in the filing. (c) The department shall mail the final order to the insurer and post the final order to the department’s website. (d) The final order must include: (A) An explanation of the findings and rationale that are the basis for the final order, including any actuarial or other analyses, calculations or evaluations relied upon by the department in its findings or rationale; and (B) Notice of the right of the insurer or any person adversely affected or aggrieved by the final order to petition the Director of the Department of Consumer and Business Services for reconsideration, in accordance with subsection (5) of this section, no later than 10 days after the date that the final order was issued. (5) If the insurer or a person adversely affected or aggrieved by the final order timely petitions the director to reconsider the final order: (a) The requester may not substitute new facts or data for the facts and data that were submitted by the insurer in the filing, but may provide a brief, memorandum or analysis based on the evidence contained in the filing or received and considered by the department during the public comment period; (b) The director may not delegate the decision-making authority for the request for review to any other individual; (c) The director shall issue a final order upon reconsideration no later than 30 days after the petition for reconsideration is received by the director; and (d) The final order upon reconsideration shall: (A) Include an explanation of the findings and rationale that are the basis for the final order; and (B) Be mailed to the insurer and posted on the department’s website. (6)(a) If, following the issuance of a final order or final order upon reconsideration under subsection (4) or (5) of this section but before the effective date of the premium rates approved by the final order, an event occurs that materially affects the director’s decision to approve the rates, the director may open a new public comment period for a period of time that the director determines is necessary to receive comments concerning the event. Based upon the event and the public comments received, the director shall affirm the final order or final order upon reconsideration by providing a written explanation of the basis for affirming the final order or final order upon reconsideration or issue a new proposed order, as described in subsection (2) of this section. (b) In the consideration of public comments or the event described in paragraph (a) of this subsection or in issuing any new proposed order, the director: (A) May not consider new facts or data that are offered as a substitute for the facts or data submitted by the insurer in the original filing. (B) May consider supplemental facts or data reasonably related to the event described in paragraph (a) of this subsection. (7) A final order or final order upon reconsideration issued pursuant to this section is subject to review under ORS 183.484. (8) Subsections (2) to (