Massachusetts Ass'n of Health Plans v. Murphy

27 Mass. L. Rptr. 77
Procedural entryThis page is a short order in Massachusetts Ass'n of Health Plans v. Murphy. Read the opinion of the Court — 27 Mass. L. Rptr. 68
Massachusetts Superior Court·Decided April 23, 2010·No. No. 101377BLS2·Published

Opinion

Neel, Stephen E., J.

On April 5, 2010, plaintiffs Massachusetts Association of Health Plans (MAHP) and associated individual health plans (Plans) filed this action, and moved for an order enjoining defendant Joseph G. Murphy, Commissioner of Insurance (Commissioner), from prohibiting or preventing the Plans from charging and collecting increased rates from small group and individual subscribers effective April 1, 2010. On April 12, 2010, after hearing, the Court denied the motion.2 The Commissioner now seeks an injunction ordering two of the Plans, Harvard Pilgrim Health Care, Inc. (Harvard Pilgrim) and Fallon Community Health Plan (Fallon),

to comply with the disapproval letters he issued on April 1, 2010, including, but not limited to, his direction that, as a result of his disapproval of new rates proposed for April 2010, they must use the April 2009 base rates, subject to applicable, approved rate factor adjustments, for coverages issued or renewed to groups in April 2010.

Commissioner’s Emergency Motion for Injunctive Relief, at 1. Plaintiffs as a group, and Harvard Pilgrim and Fallon individually, oppose the motion.3 After hearing, and review of the memoranda, affidavits, and other materials submitted, the Court concludes that the Commissioner’s interpretation of the relevant statute and regulations is reasonable and deserving of deference by the Court, and that, during the pendency of administrative hearings and appeals in this matter, relief which the Commissioner seeks is necessary to prevent further disruption of the small group and individual market and of the regulatory scheme through which that market is managed.

BACKGROUND

Following the Court’s April 12 Order, the Commissioner issued a letter to the Plans informing them that they were failing to make their health benefit plans available in the small group market and were refusing to provide prospective insureds with pricing information as required by law (April 13th Directive). The April 13th Directive further states that the Plans are obligated under G.L.c. 176J and 211 CMR 66.00 to offer and issue policies and to provide prospective insureds with rate quotes upon request at all times. See, e.g., Affidavit of Commissioner, Ex. 2, 3. The April 13th Directive extended to April 15 the time within which each Plan was to certify that it had submitted recalculated rate quotes to all of its distribution channels.

By April 15, 2010, each of the Plans had filed with the Division of Insurance (Division) letters and accompanying certificates of compliance and evidence of coverages as requested in the April 13th Directive. The Commissioner states:

All of the Carriers, except Harvard Pilgrim and Fallon, complied with the directive and demonstrated that they were implementing, or making a good faith effort to implement, the base rates from April 2009 for the April 2010 affected Small Group members and individuals and had assured the Division that such rates were being quoted through their distribution channels.

Commissioner’s Aff., para. 17. Harvard Pilgrim and Fallon, on the other hand, filed letters indicating that they would charge the rates which they respectively filed with the Division for March 2010, which they referred to as the most recent rates which were not disapproved.

On April 16, 2010, the Commissioner issued letters to Harvard Pilgrim and Fallon informing them that he found their use of their “last approved rates,” rather than the April 2009 rates, to be non-compliant with the Division’s instructions. On April 16 his counsel served and filed the present motion for injunctive relief.4

DISCUSSION

When a private party seeks a preliminary injunction, it must first show that an irreparable injury, not capable of remediation, would occur without immediate injunctive relief. Packaging Indus. Group, Inc v. [78]*78Cheney, 380 Mass. 609, 617 (1980). Aprlvate plaintiff must also show that there is a likelihood of success on the merits of the case at trial. Id. An injunction may properly issue only if the Court “concludes that the risk of irreparable harm to the plaintiff, in light of his chances of success on his claim, outweigh the defendant’s probable harm and likelihood of prevailing on the merits of the case.” Commonwealth v. Mass. CRINC, 392 Mass. 79, 87-88 (1984).

When, however, “a suit is brought ... by the government ... to enforce a statute or a declared policy of the Legislature irreparable harm is not required.” LeClair v. Town of Norwell, 430 Mass. 328, 331 (1999). Because the representative of a government agency is “acting in accordance with his broad common law and statutory powers to represent the public interest . . . ‘[t]he standard of requiring a demonstration of immediate irreparable harm, employed in civil litigation as a condition precedent to the granting of injunctive relief, is not a prerequisite to the allowance of an injunction to the plaintiff in this case.’ ” Mass CRINC, 392 Mass. at 88-89. Rather, in a case like the present one, the Court must determine first whether there is a likelihood of success on the merits of the claims, and then determine whether “the requested order promotes the public interest, or, alternatively, that the equitable relief will not adversely affect the public.” Id. at 89.

Pertinent to the Court’s determination of the Commissioner’s likelihood of success on the merits is the degree of deference due his interpretation of his authority. “A state administrative agency in Massachusetts has considerable leeway in interpreting a statute it is charged with enforcing.” A. Celia, Administrative Law and Practice, §747 (1986). An agency’s interpretation of a statute and properly adopted regulations must not be rejected unless it cannot be reconciled with the governing legislation. Nuclear Metals, Inc. v. Low Level Radioactive Waste Mgmt. Bd., 421 Mass. 196, 211 (1995). Thus if the Commissioner’s interpretation is, by any reasonable construction, in harmony with the legislative mandate, the Court must accord it considerable deference. Id.

A. Likelihood of Success on the Merits

The legal question raised by the Commissioner’s motion and the plaintiffs’ opposition is this: in light of the Commissioner’s disapprovals of the Plans’ submitted rates for small group and individual contract renewals and new contracts effective April 1, 2010, what rates apply to those contracts during the administrative appeals process now underway? The Commissioner argues that the applicable rates are the April 2009 base rates, as adjusted according to non-disapproved rating factors. The Plans argue that the applicable rates are the “last approved rates," i.e., those rates submitted and not disapproved for March 2010.

To the extent that the parties addressed the issue in their submissions and at the hearing on plaintiffs’ motion for injunctive relief, the Court concluded, in its April 12 Order, at 18, n. 13, as follows:

there appears to be no real dispute that, in the wake of the Commissioner’s disapprovals of the April 2010 submitted rates, the rates which the Plans may charge small group and individual subscribers are the April 2009 base rates as adjusted by rating factor adjustments which the Plans have submitted and which the Commissioner has not disapproved. See Beagan Aff., paras. 25-26, and Ex. 3.

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Massachusetts Ass'n of Health Plans v. Murphy, 27 Mass. L. Rptr. 77 (Mass. Ct. App. 2010).

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Massachusetts Ass'n of Health Plans v. Murphy
27 Mass. L. Rptr. 68 (Massachusetts Superior Court, 2010)