WA: Seattle Children’s Still Pressing Case Against OIC on Network Adequacy

Seattle Children’s Hospital is still pursuing its case challenging the Office of the Insurance Commissioner’s (OIC) decision to approve health plans for the state’s exchange that do not include the pediatric hospital in their provider networks.

Last October, Seattle Children’s filed a demand for an administrative hearing so that it could present its case before an administrative law judge.  The hospital is contending that some plans approved for the exchange are not in compliance with the federal Affordable Care Act because the plans do not include Seattle Children’s in their networks.

OIC lawyers filed a motion in January to dismiss the hospital’s demand for a hearing.  Three insurance carriers that were granted the right to intervene also filed a joint motion for summary judgment.  Premera Blue Cross, BridgeSpan (an affiliate of Regence BlueShield) and Coordinated Care argued in their motion that there is no law that supports the hospital’s position.

However, Administrative Law Judge Patricia D. Peterson recently denied the OIC’s motion to dismiss and also denied the carriers’ joint motion for summary judgment.

The parties are still waiting for Peterson to issue her decision on a motion for partial summary judgment filed in January by Seattle Children’s hospital.

In that motion, the hospital, referring to itself as SCH, asked the judge

to determine as a matter of law that the OIC: (1) failed to follow controlling law requiring Exchange plans to include pediatric hospitals such as SCH; (2) failed to give required consideration to the unique pediatric services available in this state only at SCH; and (3) failed to give required consideration to the fact that SCH is not an ‘in-network’ provider in these Exchange plans.  Based on these rulings, the approvals should be vacated and remanded to the Commissioner for consideration under proper standards.

Peterson’s order on the motion is likely to be issued this week, according to her staff.

The order could resolve all of the issues as a matter of law, in which case there won’t be a hearing.  But if there are issues remaining after her order, a hearing will be scheduled, staff said.

Children’s hospital and the three carriers that have chosen to intervene have all hired outside legal counsel from leading Seattle law firms to represent them in the proceeding.