 And then the RBC that we've been talking about is that what level is that at? Is that for MVP health plan Inc? Yes. And so what entities operations impact that RBC just those underneath MVP health plan Inc? Yes, I yes our financial statements like our annual statement this one we're looking at here is for MVP health plan and that has its own separate financial statements as MVP are other you know article article of business and so yes this I mean if you're interested in the businesses like the the markets that impact this it would be most of it be New York small group and individual Medicaid Medicare. And some a portion of our New York large group business a portion is on another block another legal entity and a portion of our small group business in New York is also on another legal entity but the. The vast majority of MVPs membership and revenue is under MVP health plan. And it's sort of taken away through your testimony that the care boards decisions on MVPs rate request the modifications downward have had a negative impact on the RBC for MVP. Is that a fair characterization of your testimony. I, I want to say yes I'd say the the losses due to rate cuts have had a downward impact I will say I do want to clarify that it is not the sole reason that it could have gone down or it is not the sole driver of anything it is a contributor. Fair enough that makes sense. What are the other contributors. It would be performance of all of any of those businesses that I that I just listed. It would also be investment performance and things things of that it's things that would impact things that would impact how much capital you should have so that would be running your businesses and then things that impact the capital you do so it should be it should be something that is you know could maybe even potentially be derived from the finance statement but I'm I'm not that sure to be honest but if if that's a if that's something you're interested and I'm sure we could we could help articulate that to you. Yeah, I think that would be helpful. Just parts public or not so please answer accordingly. But my question is, what is MVP's current RBC, and then where do you think the RBC should be where would you like it. So current is public it's in one of the documents that of course I don't. I think it's an L and E's memorandum, which I was like 389 or something then. It's in the threes. Yeah. Maybe exhibit 21 has it here. 369. And what we would like it to be as a question I'll defer to the financing there's a lot of things that go into RBC so RBC is a is a measure of Solvency tries to be I will say it's not it's certainly not perfect. A low a really low RBC is is a definite signal of solvency issues but a RBC of 10,000 doesn't mean you're doing any better as a company than an RBC of 800 it could just mean you're sitting on more cash right you could invest that otherwise and buy down your cash for other things and it could lower your RBC but not really. So there's a like a healthy corridor type of thing so it in terms of what our company targets for an RBC I would defer to the finance team in the CFO to answer that question for you. An MVP has a Medicare Advantage plan is it just have one or is it have multiple. Can you define what you mean by like benefit offering. Yes, are you I think you're the administrator for the UVM. Yes, Medicare Advantage plan. So there's, I believe there's three different types of three different types of UVM plans. And then, if you're speaking to just Vermont that's Vermont in New York we have numerous, but you the UVM health Advantage plan is MVP's Medicare offering in a broader sense yes. And when did that when did that plan start operating. It started operating in 2022. But MVP did have Medicare business in Vermont before. Okay, because it still have MA plan business in Vermont aside from UVM. No, it's all it all got rolled into that. So as I understand MA plans the early years can be more difficult financially and then later years can be more profitable. Are there any losses dragging down the RBC at MVP from the Medicare Advantage plan. That is certainly possible. As, as far as the quantification of it I would say that would be included in your prior ask. I will say that the membership in the UVM plan is is much in our Medicare in Vermont is significantly smaller than the commercial block or any other block we have so the the total impact could be mitigated. I'm going to switch topics a little bit. Was it your conclusion that the rates submitted to the board for approval where I should say the rates is affordable. I'll be careful with my wording. I believe what I answered directly was that what we have provided could lead to a conclusion that they are affordable. I think it it depends on your definition of affordability and how you're measuring those factors. I think MVP does everything in its power to promote affordability and you know the best that we can within the limits we have. Okay. So the wording is promotes affordable or could lead to a conclusion but you're not concluding this rate is affordable. Is that correct? I don't I don't have a definition for which to gauge that against but I sitting here now I wouldn't make the statement without having something to measure against. And do you have anything to measure against? I don't not not I'll say I could I we could MVP could create our own measure of affordability but as as Eric pointed out earlier. I am not uniquely qualified to make that assessment that everybody would stand behind from a you know a third party opinion type of standpoint. I appreciate that. You said and I think it was in your direct quote we can make our own assessments of affordability close quote and I was trying to understand what you meant by that and how you would do that. Yeah. So I think it's I think it's totally subjective to be honest. I think in the individual market I think the subsidies lead to a position where you could say that that's the federal government's definition of affordability based on your percentage of federal poverty level. The the piece that we struggle with with affordability in the small group market is we have no insight into what the member pays. We know what the group gets charged but we don't know how much that employer passes on to the employee. It's not in our data we could get anecdotal here there but I mean there's groups of three groups of 10 right there's just a ton of there's a ton of groups that are very small so we don't know. Day to day what if we're asking for 12 and a half percent on small group we're not sure if if zero of that gets passed through because the small groups doing well or if 12 and a half gets passed through or more than that because. The employer is doing poorly and they have to cut back from even where they were the prior year right so that's that's an unknown to us. We think that the individual market is kept affordable through the federal government and their definition of it but small group is a. A gray area because we just lack data so that leads us back I you know I will. Circle back to we try to focus on everything we can do to make them as affordable as possible because we feel that's. That's the main thing we can control so how do we keep administrative costs efficient how do we. Keep cost containment in light right what do we do to make sure that the Vermonters have the most affordable rate that we can provide to them. Great thank you for that and I appreciate it on your direct walking us through. Your admin costs and how they compare relative to others in the industry I thought that was really helpful so thanks for that. Are there any levels at which you think I or my fellow board members should start having concerns about the affordability of this rate so these rates these rates are. Without a reduction around 15% would you say that's a level where we should start being concerned about affordability or do you think that threshold should be higher or lower or do you not have an opinion on that. I don't. I don't feel it's my place to a pine on that what I will say is that. It is a fact that you know and Eric Eric's brought a lot of data to support it but it is a fact that healthcare costs continue to outpace. Any states you know income or anything like that so that is a real problem not in Vermont but in the entire country and lots of the world right so that is a problem that we're all facing and. You know as with medical annual medical trend of 7% that's already double you know what. Cost you know inflation is or what the you know real wages go up that sort of thing so I don't I don't know how to answer your question to be honest with you but I. I understand you know I understand that the concern and in the point. It's just. I'd you know I'm not I'm not sure what that's what that line is. Okay thank you. You use the phrase I think it might be from the rule or the reg but the rates that you MVP put forth are not excessive. When you say not excessive by reference to what what are you referencing when you say they're not excessive. I. My definition of excessive is. Kind of backed into through not actually sound like it would be us saying you know we want 20% medical trend when the hospitals are asking for seven right it would be these caught what you're asking for does not. Just cover your cost to get you back to your your target margin but it's it's way more than that so you're. Passing those costs on the consumers out of you know no necessity of your own you just want to. So I don't I don't think you know it's more of an informal definition to me but I don't think we're gouging customers I think we're as I said with why we chose 1.5% CTR. I think we need to put our best foot forward and really ask for the rate that we feel we need not something that leaves us in a position to harm Vermonters further on a cost basis or pass more costs on to them. Just because MVP wants more money we just we just want to get where we feel like we need to be to operate sustainably. Right so what I'm taking away and I'm not trying to put words in your mouth but what I'm taking away is the costs that roll up to these requests are all based on things that we don't have a whole lot of control of that MVP. So they're not excessive because we're not tacking on additional maps right like when I. This is a terrible example but I'm a golfer and when you buy golf clubs they tack on my heck of a lot more cost on them and that's just for pure profit. What you're saying it's really more controlled to the inputs that you're receiving that is that what you are trying to get at. Yeah yes and I think you know you can look at our I think a good thing to look at in in our situation is our target loss ratio. I think our target loss ratio in Vermont is ninety one ninety two percent ish the federal standard or rebating is between 80 to 85 percent depending on the size of the market. So we're you know seven to twelve points higher than that which mean you know in our opinion means we're navigating this and we're charging premium for only the things we need to cover. We could go all the way down to 80 and not have to pay money back for the federal regs right so that would be maybe excessive because if you're not spending that money why do you need to take it in right. But we are paying out ninety two cents and projected in claims for every dollar we get so we feel that that's appropriate. Do you have you had quantification percentile basis for your admin costs. Do you have similar information as to where your target loss ratios are on a percentile basis vis-a-vis your peers. I don't I would I would defer to Ellen if they if they know that information. I know on the profit I shouldn't say profit on the CTR they did and it was twenty third percentile for the CTR. But as far as you know then the main two items that go into your loss ratio being not 100 percent are admin in CTR. So if we're very low percentiles in both of them I would assume that would come together to give you a pretty low percentile on target loss ratio. I know you know ninety two is pretty high. Great. Thank you. I don't want to get too weedy on the exhibits but I think it was exhibit forty six. There's I think it was that one. There's some discussion about adjusting the rates that MVPs requesting based on the hospital budgets which I understand to be your testimony. You saw these new budgets and then the rates were adjusted accordingly. My question is did MVP make any changes to its rate requests based on what non hospitals requested. I will say what non want to say is carefully what we're altering is due to the total spend. And I will say that the Green Mountain care board oversees. So if if there are physician offices owned by a facility that is is regulated by the Green Mountain care board that is included but we are not adjusting for anything that MVP contracts with outside of the Green Mountain care board whether it's in New York the rental network anything else like that. Those are more we do those negotiations in those conversations internally and that is on a timeline where we have a better knowledge of the number by the time we file then for the Green Mountain care board hospital budgets which we know aren't going to come out till July but will impact the rates. So I think it's a timing concern more than anything else. I saw that phrase somewhere rental. What was that referring to again just remind me. Yes. So MVP has its its domestic network which covers majority of New York and Vermont and then for all members who buy Vermont all Vermonters who buy MVP products also get access to MVP's national network partner so they can go anywhere and get in network coverage within the country. Right. If the care board were to approve the full rate requests. How does MVP determine how to divide up their rate increases request by what called the GMC be regulated entities and the non GMC be regulated entities. Or the. You mean to like in negotiations. Yeah. Like what what are some of the factors that are considered in determining how much of that rate increase goes to independent primary care practice here hospital there Dartmouth here. I have what drives those decisions. Yeah I would I would say preliminary budgeting so the you know budgeting that we do to try to. Before we file rates determine where it's going to go. And that is I mean that is a reflection of the trends in our rate filing what we expect to happen at these facilities and we stick to that and. I wouldn't say it's. I'll stop there and I can continue that in the executive session if if if we would like. I was going to give you a little more detail but I think it's confidential. So is that what you're referring to now is that the confidential portion of exhibit 47. It is related to that yes. Okay. So without getting into the confidential portion what I'm trying to understand is like what are the factors that are considered in determining how much of the rate increase is. Provided to whom. Yeah I think I don't think it is looked at as. How much of the rate increase goes where as much as it is. Here's. Here's what you have budgeted for for this place. We need to stick to that right or. Something like that versus. Okay the Green Mountain care board gave us. 15% now now let's go back to the drawing board who gets what it's that it's my understanding that's not. My understanding that's not the process. You said it's based on what's budgeted for different types of providers is that right. Budgeted. Slash what we've what we put in our rates. And what's that based on. The Green Mountain care board facilities are based on the submissions. And or the prior submissions if we make an assumption. The other facilities are based on either. Ongoing negotiations or the best estimate of. Future negotiations. And that is I mean it's a collaborative process between. You know it goes all the way up the chain to to understand. You know what are our projections for next year. Okay. You know our goal and mission as a care board is you know the three legged stool as they refer to it affordability quality and access. Are any of those. Concepts included in how MVP determines where to allocate its rate increases. Yes, I think. Quality. I would argue all of them are I would argue all of them are in some in one way. Or another. Okay, and. I'm going to share what I think that means to me anyway and you can share with me what you think it means or what it does actually mean to you so. You know if I were making allocation decisions with a certain amount of money that I have. And I'm looking at quality I would be inclined to give more money to a place with high quality. I'd be inclined to give more money to a place that has better access. I would give the inclined to give more money to a place that is more affordable to keep them sustainable if if they don't if they don't have so sorry if they have sustainability challenges. I would give the money where that's going to happen is that kind of consideration done at MVP when you're deciding where to allocate resources. Yes, yes and that gets. Yeah, that gets deeper into fixed perspective payment models and all those sorts of things where we could go into great detail and talk for quite some time about how all those things played together and how. We're trying to and I think is is the new wave of health care trying to replace the traditional fee for service with something that does promote affordability quality and access through not just a, you know, pay pay when you go system. I'm going to another topic. I saw that there was some movement in the volume of membership at MVP. And I saw some answers on this but I didn't quite grasp all and what I'm trying to understand is whether or not you see any correlation knowing it's very likely not one for one, but between the cost of the product and the volume of membership. Certainly, I think it is likely. The The significant driver. Okay. Do you have any sort of documents or resources that study that and again just anecdotally what I'm thinking is if it's true that costs impact your membership, having a low membership is negative because it will increase your admin costs that will be a killer right like the lower you get worse off the business is. And so I would want an analysis of like the price points that hurt my efforts to have sufficient scope. Does MVP have that kind of analysis. I would say we engage in all our priceable markets. You know, mainly commercial we engage in strategic decisions around those types of things where we try to understand, you know, it's part of it's making a decision. Assuming what somebody else is going to do now in Vermont it's a little bit easier because you have got one competitor you're going against versus in New York there's 20. So trying to understand what happened to them and what they may do and what that might allow you to do differently to get to the place you want to be is a little bit of a circular exercise but an exercise that is fruitful nonetheless and and we do do that and try to understand. Right like if we yes if you raise your premiums too much then you risk losing half your membership and then the half the membership you're going to lose is going to be the healthy membership you're going to be left with the sicker members and then you're just you're done right as as you said and. And so that all does come into play but that all is balanced out by. Is this market sustainable how do we achieve the results we need to achieve at the same time right so it's it's not just. You know. It's not like we're Apple right and we can say what do we price the iPhone at because everybody's going to buy it anyway so who can right like what's our optimal situation and we have. The bank it's a different story where we have to take that extra that third variable into play and say and where can we price it to also be sustainable at the same time. Just got a new iPhone on Saturday and your analogy there is correct. Unfortunately for my bank account. Coming at it from that perspective do these rates that are requested give you any concern about decreasing membership and if not why not. I as they sit right now. Not necessarily I would be happy to talk you through strategy decisions and what we're thinking but I. To assume our competitors are on the line here and I don't I don't I don't want to go into that information that might give anything away. Understood. Yeah and what I'm getting at you know from a solvency perspective it's not just the dollar amount of the rate that you get it's also whether or not that membership stays robust enough to continue the operations. Related question in terms of shifting membership in the different metal levels. Do you see the cost of premiums and of the health insurance having an impact on what level of insurance people have. Yes I think generally there's been a buy down over that's generally what you see year after year is people buying down until you know spending the same amount of money to get less for it right as premiums go up. Now it's an interesting dynamic I'll go back to the point I made earlier in the individual market. Maybe not because maybe they're insulated from it all with the subsidies and as silver plans go up a larger amount it might actually make a gold. Attractive right so that that can skew what would be traditional price based decisions because that's not really what they're paying. And then in the small group market. It's also hard to know because it's not. It's not consumer driven the member necessarily doesn't always have the choice of. I want a platinum versus I want a bronze the employer is going to give them options and what the or not and just say this is your plan. So what the employer decides is a different decision making set but to answer your question in a broader sense. Yes I think benefit average benefit richness of the membership face goes has gone down over time due to increase in cost. All else equal. I'm going to try and speed it up a little bit just to be respectful time but the subsidies we touched on a little bit. When do those go away as of current plans. It is my understanding that in twenty six they would no longer be effective so through twenty twenty five. So that next year's rate review will be the last time we have them as part of our. Yeah OK yeah unless the federal you know the federal government chooses to extend or do whatever I know it was a kind of a last minute decision. This past time to to extend so I'm not sure. I mean anybody's guess what happens there. And so if you go to exhibit twenty page four. Really four five six and seven. You see these are charts from L and E of the portion of income to buy the lowest cost plans in different metal levels. And you see there generally in all these charts they're higher in terms of the percentage of family income in twenty one and then it drops down in twenty two. And this goes to your point about you know these these the federal programs subsidies make them more affordable right. And so in twenty six. If these are not. If the subsidies are not renewed or continued. Are you anticipating that these charts will go back up significantly to account for the absence of those subsidies. All else equal yes I would be and I'm. I'm not sure L and E may have spoken to it or could speak to it as well but I would be concerned about some sort of shock event where people drop coverage or do other things. So while these numbers may the numbers will go up in twenty six if there's no subsidies extended. I would be also concerned with the dynamic impacted out on the market of right like OK I went from having to pay five percent my income and now it's. I can't afford that's why I no longer have insurance right. That's obviously not the outcome anybody wants but in a consequence that could come of it as well. So the numbers will go up but there's more to it than that as well. Right. That's sort of my concern is that these rates are going up and just to be totally candid in my mind part of it is OK. Well we have subsidies so it's not as bad as the actual absolute number on the rate. But then we might have three or whatever three years of rate increases with that consideration in our head and at least the potential that that goes away. And there's a real whipsaw for the consumer on this and a little concerned about that. Does MVP have any thinking or plans around that potential contingency and what to do about it. Not at the moment. I would say that I'm I'm sure MVP would lobby to its extent to continue. And I know we did the first time to continue the subsidies because it doesn't matter like MVP doesn't care necessarily whether you're getting a subsidy or not from a revenue in standpoint right. It just comes from the government. So we would rather more people be insured and that helps the overall health of the population and the you know that helps bring costs down. The more people that are insured. You know that goes back to the the genesis of the ACA with the individual mandate is the bigger the pool. The less you can lower the overall morbidity of the pool rather than having only the people who need it insured. So I think MVP is all for everybody getting the care they need. But in terms of what that would do to the member I'll be honest. I'm not sure at this time what like how we could impact that other than continuing to push. I'm sure as all other health plans will be to continue these subsidies. Right. You may not have this. So I apologize with a little far field. But do you have any MVP any projections as to what that could do to the membership volume that you have if the subsidies go away entirely and the rates are significantly higher. I mean it's part of your lobbying effort that might be relevant information to what that would do to the market. Yeah I don't not at this time. I think it's probably a little bit early. For that. I think this is my last question. Dr. Mermin spoke a little bit about that with you about the cost containment and quality initiatives. And you said there was a PM PM associated with that. The cost containment and QI efforts is to lower costs. Right. Correct. Is there a corresponding PM PM savings that correlates to those cost containment and QI efforts. Yes so this and this is very much related to this to the similar question on the prior authorizations right we can we can tell you what it costs to administer. More like what a cost to do the authorizations. And we can have a calculated ROI on such programs. Which then could back you into the savings but ultimately the savings are in a reduction to claims right so the savings are implicit in our experience to the you know and that's why I made the comment we continually. We are evaluating the performance of these things because if we determine we're spending money to have a cost containment initiative that's not containing costs then then you are spending money without reducing the claims at at least as much if not greater level it doesn't make sense right then you're just wasting money. So yes there is always a positive or there should always be a pause equal or greater offset to that but that happens through the claim expense it's not a tangible like separate line item. It's just medical claims are lower we had less of this because we did this we drive people to higher value care which reduced this type of thing. And that's what I'm getting at you have that data that shows are you evaluating your cost containment and QI efforts to know that you're breaking even or saving money in that reduction in claims. Yes, it is a iterative process that I would say we are can we are still continue to work through so it I wouldn't say it's 100% comprehensive at the moment in terms of we could you know won't be able to turn around for you by the end of the week a full list of everything in there are wise and here it is. But we're continuing to evaluate and we have made changes recently to things that we didn't do more valuable so it's it's working through all the programs to make sure again that MVP spending the money we should spend so it is a it is something we are doing but maybe not something that is 100% offhand at hand ready to go. I have no further questions for you Mr pontiff and thank you very much for your patience and time and I'll turn it back to you hearing officer. Thank you. Are there any board questions, or I turn it over to see if miss Bella load has questions. Just a few board questions. Chair Foster brought up something on the RBC. So money that's set aside as RBC for a period of time. Is that money invested in the market. Or invested somehow. It is my understanding that RBC your required capital well your required capital is what it takes to do business and then it's it's a measure of your actual capital so I believe that on that includes yes assets that would be invested. And then so I'm looking at exhibit 21 page 18. These RBCs this is in the. The L&E report. I'm sure it could exhibit 22 as a similar. I didn't look to see if they're the same at this moment, but I. Do you know how much of the decline in RBC from 20 to 21 was market related. I know that a lot of hospitals saw a lot of market declines with regards to their day's cash on hand. Did MVP experience a decline related to market value of their invested RBC capital. I would question this is something that should be discussed confidentially. I don't know. Maybe. Yeah I'm not sure if it's confidential. I just don't want to give the wrong answer. So I know that you know the investment performance matters. I I don't know how much of it is for that. I'm just you know we've been implying that you know the the loss of the Vermont business for MVP could impact the RBC. You discussed different things that impact RBC. And I'm trying to understand what the impacts of those various things is and if if investment losses. If it impacts on RBC in this time period or if this is more due to loss secondary to rising costs of health care related to premiums. Yep. A valid question. I don't. I don't have the answer off hand. Is that an answer you think we could get as a board even if it's confidential. I would I would think so. I would have to defer to the accounting team. I mean they calculate the RBC the the finance crew but it what goes into that RBC we should be able to lay out the pieces of it. I mean there's going to be a there's going to be a lot of moving parts but we can help summarize what you know what may be the biggest the biggest driver. So total pivot of a different question line here. And I'm sorry I'm just going to tell a super brief story but when I was in medical school I had this mentor Paris Berman who subsequently was dean of my medical school but wasn't at the time who in his retirement came to medical school and earlier in his career he started subsequently became the Tufts health plan and I remember sitting in his office and him telling me about you know the derivation of this nonprofit health insurance company to and one of the things he said was you know he'd go on rounds in his hospital and he'd see all these you know the cardiologist and stacks of EKGs and every single patient every day that he was billing for and that that they said we needed to start a way to to ensure that our patients aren't this is kind of the opposite of the prior authorization discussion right we didn't develop a way to ensure that our patients aren't receiving all this unnecessary care that people are profiting off of and and deliver high quality care and I guess I guess I just while you were talking with chair Foster I guess I just had this question of when you think of MVP as an insurance company as a part of the health system. What is MVP's real essence of its role within that health system. It's good question I think our. You know our mission our values are to provide high quality care and not only that but high quality personalized service to our members. So I think our role as a a regional nonprofit is to provide a deeper level of care and a deeper deeper level of service to a member that they may not able be able to get other what you know elsewhere and I think the the bigger philosophical question of is the insurance company there. I think my belief is that the old school the insurance company is there just to pay my claims is not is not the way to do it. I think the we are trying to make MVP a part of their lives and in to help them understand that MVP is there for them and not not turn it into a which I fully appreciate can happen sometimes between the physicians in the insurance company where it's a physician versus MVP's physician says this and then it becomes a battle of who do I trust more who do I want to do things for me but I think what we're trying to instill as a as a culture for our members is that we are want to be a part of their life we want to help them with their wellness outside of life or outside of health care services specifically so like just day to day mental health those sorts of things we have you know wellness programs that do things like that so trying to be not just a hey when you go to the doctor let us know we'll pay for it but a more collaborative partner in their health which is I think the role of a good regional health insure versus say a national where that level of service just can't be provided so I think that's what we're trying to do is trying to get away from the again just a fee for service bill me I'll pay it and think of us as more of a partner in their in their care journey. I don't know if that answers your question. Yeah I think to a large degree does I the characterization that Dr. Berman gave me which sort of surprised me I think at the time because I probably had a different view of an insurance company was that the insurance company has the ability to be you know compared to an uninsured person who is paying cash out of pocket for everything to be kind of a leverage negotiator for more affordable prices through sort of a bulk negotiation is that something that you feel an insurance company of the role of something like of a company like MVP is. Yeah I think so I mean you know I have personal stories where you know people come to me all the time and of course you know being an actuary for a health insurance company isn't exactly you know the thing I lead with when I meet people for the first time because that generally is like OK well we all hate insurance companies so I must not like you if you're making the rates but you know I I think the insurance company MVP we do provide a valuable service and like you said paying cash out of pocket. I mean we have we have claims that come through our doors that have billed charges for two million dollars and well and because we've negotiated rates and we have you know relationships they pay for maybe a hundred and fifty thousand and that member may pay two thousand right. So that member you know one MVP negotiated a lower amount but two you know the cost share piece of it but like millions of dollars get billed on these things right and I think there is a huge service to the bulk negotiation versus the bill charges and what insurance what value insurance can provide people you know the I always like to make the analogy that if you have you know two week three week in state and that runs you two three hundred thousand dollars and you're uninsured you know are you filing for bankruptcy. Like is that how does that disrupt your life right. Does that end all financial freedom in your life for the next decade because you owe the hospital you know the facility this money and and not that that's wrong on the facility. They provided you services that are being billed for that that rate but the insurance company does provide that coverage and that level of care that can save a lot of people from a lot of financial harm. But you know that's in essence that's what the insurance business is for but I think health care is a very unique one where the the tail of cost is very very high and it protects people from truly catastrophic life outcomes that you know I think the people who get that help truly understand it and some don't until they get in that position but that's what in my opinion some of the best benefits that you can you can provide as compared to like an uninsured per se. Thank you for that. When you when you think about providing health insurance in Vermont which is you know we we discuss quite frequently in our meetings about this sort of unique state that's different between the care board how hospitals are organized our population what not. What are some are there unique challenges or are there unique uniquely easier things to do when you're providing that affect your ability to provide low-cost high quality health insurance in Vermont. It's a great question that I may by virtue of MVP not be that qualified to answer like I think Vermont definitely utilizes services differently than New York but I have an N of two right like if I if we were United here operating in all 50 states it'd be a very different answer I would probably give you because Vermont compared to New York is one thing and you know politically you know Vermont New York can be a similar in a lot of ways and have very similar say it's all community rated so there's one rate for everybody regardless of age whereas a lot of other states don't right so it's very difficult for me to say like unique challenges due to Vermont because New York and Vermont have a lot of similar challenges and benefits of their health care landscape but that's I'd be trying to find I'm sorry but I guess I was sort of thinking more specifically related to the Green Mountain care I mean you do bring up the Green Mountain care board hospitals that you're going to find out the rates later on you know we sort of seem to define the maximum rate if those provide unique challenges and how that affects your ability to set competitive rates yeah I mean it's definitely a unique situation where we don't there is no regulatory body on the facilities like that in New York so this nuance of the rate filing is definitely challenging the timing of it is challenging and I think everybody everybody who's been through it a couple of times understands that and realizes the challenges with the rates are due in May but the budgets aren't due till July but then you have to make the decision on the rates before the decision on the budgets right so it's it's a very difficult timeline for everybody to integrate not just us but but the board I'm it's a huge task for you guys as well and so it does present those challenges and understanding you know in one way it's a it's a little bit simpler because there are a lot less facilities in in Vermont than there are in New York so it's it's simpler in that regard but it's also the timing of it is is interesting and the the care boards role in it all is is definitely different I wouldn't say it is worse or better or anything but it it's just it does provide a unique set of challenges that New York does not have you know simply put thanks I don't I don't have any further questions now thanks okay why don't we take five minute break some point we're gonna have to let Chris go I the plan after we get back from break at 1251 would be to give Laura Bellovo a chance to quickly ask some questions if he has any and then turned over to to Gary for any redirect that he may have and then there was talk of an executive session I think that would best come after Jackie Lee's testimony because there are portions of the L&E reports that are confidential around the CSR issue and best to tackle all that at once so let's reconvene at 1251 and and do that okay okay I think we are looks like everyone is back so let's go back on record on the record and miss Bellovo do you have any questions for Mr. Pontiff I good afternoon yes I do I'm Mr. Pontiff hi how are you and I'm just gonna preface this by saying that my laptop doesn't always believe I have Wi-Fi I do have Wi-Fi and so if I freeze I have an iPad lined up to jump right back in so everyone remain calm if you could turn to exhibit 45 and could you estimate what the rate changes are for the silver plans versus all the other metal tiers yeah I think on average the silver plans are going up 0.4% and then everything else is down about 0.1% roughly yeah are you talking about just for the CSR recommendation from Eleni correct yes yes okay would you be willing to follow up with something that documents that calculation yes I assumed post hearing Eleni would be reaching out to confirm our confirm our calculations yeah excellent excellent okay and then turning to exhibit 46 and I would just like to confirm my understanding that the column that's labeled overall cuts proposed by Eleni yep those are cuts that were actuarially based but that MVP didn't agree to is that right that's correct yes it yes difference I'll call it a difference in actuarial opinion right but they're based from Eleni's perspective on actuarial recommendations yes all right thank you those are my questions okay turning back to you Mr. Carnegie for any redirect thank you very much I just wanted to follow up on two points Mr. Pontiff that the HCA asked you about that Eric asked you about first you don't have a legal degree right that's true and you don't have a master's degree in affordability correct I don't have any degree in any degree in affordability and you don't need to be an expert to provide information about that the board could then conclude from that information whether a rate's affordable right you don't need to be an expert to provide data correct that's correct ultimately it's the board's decision on what is affordable and whether it's affordable under the statute correct that's our understanding yes and then if you go to exhibit one please just go to the last page and tell me how many pages there are in exhibit one that's our individual rate 165 and then go to exhibit two please and tell me that's the small group rate filing how many pages there are there 162 and would you agree with me that those rate filings and all the decisions that you and your team made in the rate filings ultimately were aimed at making the races as affordable as possible yes and would you agree with me that the other pre filed testimony and then the exchanges you've had with various folks asking you questions today that's all evidence about affordability ultimately isn't it whether the rates are affordable I believe so and then the second point our Vermont rate payers subsidizing New York rate payers in the 2024 rate violence no when you set rates in Vermont for the Vermont business is that a standalone proposition or are you setting rates considering what's happening over in New York State all markets regardless of state are priced on their own do the rate by exhibit one exhibit to do those rate filings depend upon events taking place in New York in New York business no if you would go to exhibit forty six please forty six we can't hear you mister show were you trying to jet thank you can you hear me okay okay so go to exhibit forty six please let me know when you're there second column it says MVP proposed CTR you see that I do and you see how the numbers are there's two percent in two thousand nineteen and then it's one point five percent each year after that you see that I do so is there a spike in the CTR request by MVP that somehow relates to the Hudson health plan issue in New York no thank you very much that's all I have you have any questions about those points just just one point of clarification Chris so I thought I heard you say earlier that RBC is developed is calculated at an enterprise level MVP healthcare works in Vermont and New York so it is connected I would think correct objection that's beyond the scope of the question I asked I didn't ask about RBC you asked if they were connected at all to New York and I'm asking if that's true yeah I think I think it's a fair question I get the point you could sorry restate the question Eric in a little bit you just did you just say Mr. Pondiff that the rates are completely independent what happens in Vermont or what happens in New York doesn't affect Vermont at all correct I said the rates are set independently of one another so they're set I'm sorry how can that be true if RBC is calculated at the empty level of all RBC is was not a leading factor in determining the anything in this rate filing the rate filing is derived based on the data of that block and that that block needs to be sustainable on its own so we we can talk about RBC in the bigger picture at the end of the day the CTR for this filing is grounded in the long term sustainability of the Vermont individual and small group products specifically independent of its impact that it may have on CTR you don't look at the overall sovereignty of the organization Chris when you said CTR we do it is more of a binary if MVP was in trouble if MVP needed had significant solvency concerns then that could potentially impact it it is not in these filings quick so to follow up on that so you said it's concerning and not sustainable that the organization had long term losses right so on one hand you're saying it's a concern and on the other hand you're saying it's not a concern yeah so worse what we're saying is concerning is that the small group and individual rates have long term sustained losses not that MVP health plan has long term sustained losses okay thank you that's all we've referred to to move on I think at this point it makes sense to take a lunch break come back and hear from Jesse Luce here from Department of Financial Regulation followed by oh sorry I'm getting ahead of myself Mr. Carnegie do you have any additional witnesses you've had listed Julia Dora as a potential witness no not this time we might have a rebuttal witness if we put Chris back on okay then I propose we break for lunch come back like I said here from Jesse Luce here from Department of Financial Regulation followed by Jackie Lee followed by an executive session I think we have time for all that so why don't we any objections to half an hour lunch break so we convene it say 140 okay then let's reconvene it 140 and Mr. Luce here are you on yes can you hear me yes does that sound okay to you sounds good 140 okay talk everybody then thanks thank you I'm still showing you as muted how about now now I can hear you I didn't do that somebody muted me so I'm the 802 798 number my phone is wavering between one and two bars right now and I've dropped the teammate meaning several times already today so if you can't hear me for any reason I apologize let me know let's start my name is Jesse Luce here I work for the Department of Financial Regulation my official title is administrative insurance examiner I am involved in all aspects of the examination and analysis of insurance companies at a high level examination is similar to a financial audit with more of a lens towards perspective information and analysis is a routine quarterly review of a company's financial statements as noted in the Solvency Letter New York is the New York department is MVP's primary regulator and Vermont relies on New York to inform us of any solvency or concerns or issues they would have with MVP to date New York has not notified the department of any immediate solvency concerns I'll just read a couple parts of the letter as I'm normally asked to do so I know Chris had read these so might be a little bit cumbersome but stage one of the Solvency opinion the summary of the opinion states that MVP would not negatively impact its solvency in the company otherwise needs for non-financial licensing requirements for a foreign insurer and I'll skip to the final paragraph that states the impact of the filing on solvency and its filing MVP has requested that the board approve an overall average rate increase of 12.8% which was in the original filing that's going to be updated or amended from what I understand the rate is going to change to somewhere between 13% and 16% depending on how a few years ago the board approved the application of Solvency and it's going to change to somewhere between 13% and 16% depending on how a few variables shake out and the department's opinion would not change assuming that Lewis and Ellis agree with the final update so I'm just going to end it there in the interest of time and back to you Mike. Thank you Mr. Carnegie do you have questions for Mr. Lucier? My partner Mr. Long will handle the question thank you. Thank you. Good afternoon Mr. Lucier good to see you again this year. Good afternoon you too. And at any point if you can't hear me just stop me let me know and we'll repeat the question I know you have some self-reception up there. First of all I think you took away a lot of my questions and explanation was really helpful thank you. I'd like to clarify just a couple of things I think we're all on exhibit 18 but if you're not could you please go there and let me know what you're there. Are you there? Okay yeah thanks and this is dated July 5th correct? Correct and now July 5th that would have been before the L&E Actuarial Memorandum and before hospital budgets budget requests were released is that correct? I believe so and did you have an opportunity to review the L&E Actuarial Memorandum before issuing the Solvency opinion? I skimmed it I can't say that I'm an expert on I don't have any actuarial credentials so I did review it but I can't say that I fully could explain everything in there Okay but this Solvency opinion that July 5th one deals with the original rate request at 12.8% and the same in the small group the 12.5% is that right? Correct and you heard some testimony today I believe you testified to this from Mr. Pontiff that those rates may be adjusted slightly I believe the numbers that he gave were contingent on a 17% reduction on hospital budgets as ordered last year 13.81% to the individual filing does that sound right? That sounds right yeah In the small group 14.29% is that right? That sounds right And I think you already said the department's opinion on Solvency remains unchanged but that's going to be contingent on what Eleni says is that right? Yeah as long as the actuaries agree where they land So barring some disagreement from Eleni the Solvency opinion is unchanged and the department's position is that there would not be a negative impact on Solvency Correct So still on 18 can you please read for me the last sentence of the third bulleted point on page 2? Yes the one that begins finally in 2022? That's the beginning yeah just the last sentence Solvency Nonetheless adequacy of rate and contribution to surplus are necessary for all health insurance so that's the capital that keeps pace with claims trends And that's standard language in your Solvency opinions year to year correct? Yeah and we can discuss this in previous rate filings and it kind of echoes what Chris was saying that the filing should stand on its own And this year MVP sought a 1.5% contribution to reserves Is it the department's opinion that that is adequate? Yes all other things being equal Yeah that seems like it would be adequate And that's for both filings correct? Correct Could you please turn for me to exhibit 21 Exhibit 21 And this is the Eleni actuarial Yeah And do you look at this briefly is that correct? Correct And you've heard some testimony out today too right? I'm sorry can you repeat that? And you've heard some testimony today on it as well right? Yeah Could you please turn to page 18 Starting on page 17 I'm looking at the section 12 changes in contribution to reserves do you see that? Yeah And then continuing over to 18 There's a paragraph at the top that begins as a reasonable just a reasonableness check do you see that? Yeah And you heard some testimony on the reasonableness check today as well right? Yeah And you're generally familiar that in the last few years Eleni has done a reasonableness check of MVP's CTR against nationwide health plan CTR does that right? Yeah And would it be fair to say that MVP writes here sorry L and E writes here that MVP's filed CTR is somewhere in the 23rd percentile for all QHP carriers? Yeah that's what it says And so that would be less than roughly three quarters of all the QHP carriers right? Correct Could you please turn to the next page page 19? Okay And I see this page is headed recommendations do you see that? Yeah And you generally understand that this recommendations page is sort of a summary of the recommendations Eleni is making to the board vis-à-vis MVP's rate requests Yeah And to your knowledge is L and E recommending any cut to MVP's CTR Not that I can see Okay let's go back to page 18 I believe you touched on this briefly but you heard Christopher Pontiff's testimony earlier today that continued negative profits are not sustained Do you recall that? I want to look at the paragraph on page 18 just under that historical RBC ratio table Okay Can you read, and this is a little tough, the second to last sentence that begins Eleni notes Eleni notes that it is not sustainable to have long-term negative profits and therefore a higher CTR could be justified So it looks like Eleni agrees with what Mr. Pontiff said earlier today a long-term negative profits, is that right? I have to object, I'm sorry Eleni can speak to whether it agrees or not with Mr. Pontiff Well he certainly can speak to what's written on the page But you're asking him does he agree with what Eleni agrees with? Okay, with Ron Go ahead Thank you And does the department agree that long-term negative profits is not sustainable? I would agree that long-term negative profits are not sustainable No further questions, recall I believe there's a contingent on Eleni part here So subject to recall after we hear from Eleni Okay Jesse, that means you'll need to stick around until the conclusion of Eleni's testimony Turn it over to the healthcare advocate now for any questions Sure, I just have a few questions Mr. Lucier, we're going to stick on exhibit 18 and so we've known each other for a few years now and it feels a bit odd to call you Mr. Lucier Are you okay to call you Jesse and you can call me Eric? That sounds fine All for reducing awkwardness So in your in GIFR's decision it states that MVP's operations posed, Vermont operations posed little risks to its solvency Is that correct? It says that operations pose less risk to its solvency compared to New York You may have heard this it was going back and forth a few times and I think you're probably the best person to ask Is solvency calculated at the entity level? Or looked at at the entity level? Generally speaking Solvency can be at the entity and or group level? So if an organization operates in a bunch of multiple jurisdictions what happens in one jurisdiction impacts the overall solvency of the organization which has a role in terms of solvency opinion for a specific group of business Wow that was awkward All pieces of a business will generally affect the solvency somehow Okay And just to be clear GIFR states that the proposed rate will not have a negative impact on MVP's solvency contingent on the GMCBs not finding the rate inadequate Correct and that's also assuming that all of the factors all of being equal with the rate filings material doesn't change if that makes sense there's a possibility for losses because of increased costs in the future Does that make sense? So Jesse the I just want to probe a little bit it's contingent on the GMCB's actuary not finding the rate inadequate but I'm assuming would the actuary recommending that the rate be reduced change your opinion? Not necessarily I know there were a few differences between L&E and the company the most part those were those were agreed on so if L&E said I think this component should have been down by a percentage and then MVP says we agree with that then that wouldn't change our opinion What happens if the two actuaries disagree? There are things that the GMCB's actuary says should be reduced and MVP says it shouldn't I don't know how to interpret the DFR's opinion in that scenario I think we would defer to the board and the actuaries I don't have the expertise to say which one would be right nor do we have an actuary on staff at DFR So I'm going to switch gears a little bit because this may be a bit meta these questions so hopefully you can make sense of my babble Jesse So you say DFR says that the proposed rate subject to the actuary's finding that it is not inadequate will not negatively impact MVP HP's solvency, right? Right, that's what the letter said and so I'm assuming DFR doesn't know what will happen correct? What will happen with As in like, you know, you don't have some crystal ball for what will happen in the future No, the actuary estimates are their best estimates So then I'll go ahead No, no, I'm fine, go ahead I guess then I'm just thinking about how to interpret that word will I mean, is it maybe fair to say then that will is actually a may or will contingent on future costs being as predicted by MVP's actuary? Yeah, I think like I said before it's all other things being equal So assuming the the actuarial estimations are accurate to a material degree That's fair. Thank you so much, Jesse. That's all my questions during office at Barbara. Hey, Board Member Lunge, do you have any questions? I do not. Board Member Holmes? I do not. Board Member Merman? I do not, thanks. I don't thank you. Hey, Ryan, I'll give you an opportunity if you have any follow-up questions. Nothing further from me. Thank you. Great. So you can be excused now. Jesse, if you could please tune in for the rest of the hearing. It sounds like MVP may have some questions after Jackie Lee testifies. Sounds good. Thanks. Thank you. Hello Jackie. Hello, good afternoon. I'm going to swear you in now. Could you please raise your right hand? Do you solemnly swear that the evidence you shall give relative to the cause now under consideration shall be the whole truth and nothing but the truth. So hope you got. Yes. Okay, Miss Bella. Hi, Jackie. Can you please say your name for the record? Yes, Jacqueline Lee. And where do you work? I work at Lewis and Ellis. And what's your position at Lewis and Ellis? I'm a Vice President and Principal at L&E. Can you please turn to exhibit 24 of the binder? Yes, I made this name. Great. Can you please turn to exhibit 24? Yes. Can you briefly describe what this document is and the information contained in it? Yes, this is my pre-filed testimony dated July 11th. It outlines some questions and my responses for background. Can you talk about the process of how you came to prepare this? Yes, for the great filing itself. Yes. So the general L&E process is we get the filings through SERF from the carriers and we have an internal team. This year it is Allison Young who is an ASA with L&E and Tracy Hughes who is an ASA with L&E. We all take turns reviewing all of the documents and then we submit questions to the carrier through SERF and get responses in that same way. And from there we use all of that information to determine our recommendations and findings and then we present them in a report that everybody's been referencing today in exhibit 21. Thanks. And the information in your pre-filed testimony is accurate and correct to the best of your knowledge? Yes. Is there any information in the document that you'd like to change or clarify at this time? No, there is not. And do you wish to adopt this pre-filed testimony as part of your testimony today? Yes, please. And you spoke about your general process in preparing your report and can you briefly explain your role in preparation of the report? Yes. I review all the filings in Vermont so I would say I'm a peer reviewer. So I work closely with both the MVP team that I've outlined and the Blue Cross Blue Shield and the Vermont team which is Kevin Ruggeberg and Jason Darity. I work with all of those people to make sure there's consistency among how we're doing or performing our reviews ensuring that we are treating each carrier fairly and ensuring that we are hitting on any key issues that we need to drive on just as an extra set of eyes but also having worked in Vermont with the inception of our contract in 2014. We've seen a lot of filings and know the primary issues that are coming up. Great. And you mentioned that you submit your recommendations to the board with your day 60 report. Is that right? Yes, our day 60 report is how we communicate the review that we do all of the components of the rate as well as any recommendations that we may have. And this year you submitted two reports. Yes, we now have individual report and a small group report. The report for the 2024 individual rate filing is Exhibit 21 and the report for the 2024 small group rate filing is Exhibit 22. And can you turn to those exhibits? Both of them simultaneously. I'm on Exhibit 21 currently. Except we will point out where their differences but there's a lot of overlap. Do you have any changes you wish to make to either report at this time? I do not. So let's see. I did just want to raise one small thing on Exhibit 21 on page 20. You mentioned highlights that didn't turn out at least in my copy. So could you just say which items would be highlighted? Yes. The highlighted lines would be number 8 risk adjustment and number 9 extra real value. Sorry for that. Overside. And on Exhibit 20 in Exhibit 22 on page 17 there should be highlights on number 8 changes to risk adjustment and number 9 changes in actual real value. Is that right? Yes, that's correct. Thanks. Can you explain your standard of review here? Yes, our standard of review is seen on Exhibit 21 and I believe in 22 it should be very close to the theme on page 2. We have Vermont statutes and a board rule regarding rate review. Are we primarily focus on the actuarial items of the board standard of review, which consists of not unjust, not unfair and then not excessive or inadequate and then unfairly discriminatory, not unfairly discriminatory. So a lot of double negatives there. That's fine. Do you review for affordability in either filing? We do not. And why is that? It is not an actuarial defined component, so therefore it is not outside the scope of our review. Using your methodology and standard of review, did you make any recommendations to modify this proposed filing? Yes, we did. Can you summarize that? Yes. On page 19 of Exhibit 21, we recommend that the updated hospital budget information be considered at the time of this report. That information had just come out and had not been summarized and having new updated hospital budget information directly impacts the unit cost trend assumptions and we recommend that that be incorporated into the final decision. We also recommended a change for new information that came in after the filings were submitted by the carriers. CMS produces a report on risk adjustment that comes out around June 30th of every year. So that came out and we recommend that that information be used as the starting point for the carrier's assumptions. We also recommended there were some changes brought to our attention that happened after again new information after the filings were submitted by the carriers that came based on new IRS guidance which required changes to the high deductible plans. So we recommended that those changes be allowed. For the individual plan only we do have a recommendation for some changes to the CSR loads which is based on some enrollment shifting due to changes in the actual CSR guidance and Medicaid redetermination. That is not applicable to the small group filing so therefore it is not a recommendation in exhibit 22. Have you reviewed the other pre-filed testimony in this proceeding? Yes I have. And have you listened to the testimony today so far? Yes I have. Could you please discuss a little further your recommendations about updating hospital budgets? Yes since there is new information that has come out we suggest that this be incorporated as most who are involved last year knew that there were significant changes due to last year's submissions and a lot of times that is what is utilized or prior years which is not necessarily indicative of what the hospital budgets are going to come in as. And since we now know this information we recommend that it be used. I know that MVP and Chris have expressed some concern about the way it was delivered this year so we would certainly be open to ensuring that we are able to properly communicate whatever recommendation the board has. That is in alignment with what ultimately gets ordered. I will say in general I think that what MVP has proposed is in the ballpark of reasonable however it does sound like some more work needs to be done to ensure that they have a proper understanding of what has been submitted. Outside of that do you wish to amend or add to Eleni's recommendation about updated hospital budget information? I do not. And this recommendation applies equally to individual and small group filings is that right? Yes the impact is not equal I think those are used impact is not equal but the recommendation and methodology is equal for both. And can you please discuss your recommendation concerning updated risk adjustment transfers? Yes as I already stated CMS produces a report at the end of June that outlines what the 2022 calendar risk adjustment transfers are going to be for each of the carriers at submission they did not know this information they only knew information about themselves and not the market as a whole so they had to make assumptions now those assumptions are known so we recommended that they use that new information in both of the filings. And having reviewed the pre-filed testimony and listened to the testimony today so far do you wish to amend or add to Eleni's recommendations about risk adjustment transfers? No I would note that we had quantified this for the individual filing that was a decrease in rates of approximately 1.3% as part of the proceeding procedure in Vermont we requested the carrier take our recommendations and quantify them using their pricing models in VP I think it is I thought I had this handy but in carrier calculation on exhibit 45 indicates that it is a 1.2% decrease so I don't wish to modify our memo or recommendation but we would lean on MVP's calculation of that number And can you please discuss a little further your recommendation concerning paid to allowed ratios? Yes for the paid to allowed ratios this is an impact when there are changes in plan designs before or after the findings were submitted the IRS had issued guidance about high deductible plans and plan designs for the high deductible plans or ADHPs and that guidance required a change to some of the plan designs that had a minor impact to some of the plans so we're recommending that that be allowed by the board to properly reflect the IRS guidance that came up Great and having reviewed the pre-filed testimony and listened to testimony today so far do you wish to amend or add to Eleni's recommendations on the paid to allowed ratios? I do not And then for the one recommendation that affects the individual filing only can you please discuss your recommendation related to cost sharing reductions to the extent possible without getting into confidential information? Yes so in March the board issued guidance regarding CSR loads and how they should be calculated based on that guidance NDP made pricing adjustments without making any membership shifts and our report outlines all of the pieces I won't go into each of them because some of them are confidential but it's outlined with on pages it starts on page 11 of exhibit 21 and goes through it's like 14 so we gathered some additional information from NDP including shifts between different metal tiers for prior years and including some information about the current population looks like and based on that information we assumed enrollment shifts and as I think has been discussed in a little bit of detail there's a little bit of a circular nature to it because when people are incentivized or they use their decision making to make different decisions when they are presented with a premium and as that premium changes they may modify those and so as you quantified by NDP some of the rates went up and some of them went down and so different decisions are made so therefore we had some movement we felt that based on the historical changes that they were appropriate we've also cited some other instances where this has happened there's been additional guidance and there has been membership shifting that warranted a change here and then that change resulted in the best way we could determine it was we put forth what the CSR loads should be and allowed NDP to kind of take it the rest of the way with any potential morbidity shifts and how that would impact other metal tiers. So having reviewed the pre-file testimony and listened to the testimony today so far do you wish to amend your add to L&E's recommendations on the cost sharing reductions? I do not. If all of your recommendations were to be implemented can you explain what the ultimate projected rating would be? I'm going to rely on NDP's calculation because as I just stated regarding CSRs we did not have a full calculation and a full calculation for the CSR load as well as noted earlier for the individual we had a 0.1% difference so based on that the new increase for the individual filing as calculated by NDP is 11.6 based on all of the recommendations in our report for small group filing the new rate increase is 11.8% So do you find the 11.6% increase reasonable in the individual filing? Yes and can you tell me why you find it reasonable? We looked at all of the assumptions and determined whether or not they met all three of the criteria that is outlined in the pre-file testimony pretty clearly with definitions of not excessive, not inadequate and not unfairly discriminatory and if it met those then we determined that they were reasonable so we went through all of those and that is how we determined that the rate was reasonable for the individual market of 11.6 Okay and do you find the 11.8% increase reasonable in the small group filing? Yes and can you briefly say why you find it reasonable? Sorry to ask, basically the same question twice. That's okay for the same reasons we used our actuarial defined plan or defined definitions that determine actuarial soundness of not excessive, not inadequate and not unfairly discriminatory and since we were able to identify that for all of the assumptions and the assumptions in aggregate we determined that the 11.8% for small group was reasonable. Thank you. So after reading the carriage pre-file testimony and all of the materials that have been submitted so far in the filing and then listening to today's testimony is there anything you wish to add or change to the four recommendations for the individual filing and the three recommendations for the small group filing that we have covered so far? No, I would like to caveat that for the individual filing we do have some questions about some of the numbers quoted for the morbidity, what we're calling the morbidity change but the change due to the CSR loads. On the onset it appears reasonable however we just have not seen any backup so to the extent that there is some minor disagreements we would work with MVP after hearing to just see their backup to ensure that that's appropriate still. Outside of that no further changes or commentary on it. Great and given that caveat if your recommendations as of today are implemented do you believe that rates would be excessive? No. Do you believe they would be inadequate? No. And do you believe they would be unfairly discriminatory? No. Thank you Jackie I have no further questions at this time. Any questions from MVP? Yes the first question I have good afternoon Miss Lee how are you today? Great how are you? The first question I have is I wrote it down we've been doing this for 10 years is that right since 2014? I don't know really? 9 maybe 9. That's that math thing again. Thankfully they weren't zooms early on so somebody could see how much I've aged over those years. Would you go to exhibit 45 please? I am there already. Thank you. So I just want to confirm I think you testified on direct I just want to confirm this is the exhibit where MVP plugs in L&E's assumptions into their rate software to confirm your math. That's sort of a lay person description of it. Is that fair? Yes that's fair. So I just want to discuss the calculation adjustments that were made and that would relate to number one where for individual L&E had 1.3 and MVP calculated L&E's decreased to be actually 1.2 do you concur with the 1.2? Yes. And then 2 is inapplicable to my question 3 the .2 decrease for individual and small group that you suggested that remains unchanged so we had agreement on that correct? Correct. And so if you would go to exhibit 21 please which you're right we talked about that a lot page 19 that's L&E's four recommendations Yes. And then if you go to exhibit 22 page 16 that's L&E's three recommendations correct? Correct sorry. And so that small group the reason there's three and not four is because the CSR load issue was just an individual filing issue correct? That's correct. So with the exception of the CSR load issue which which you testified to that's limited to the individual filing when I ask you questions in cross examination do you understand that the questions I'll be asked will relate to both filings so just tell me if there's a difference in the filing in your response if you could. Okay. Thank you. Alright go to exhibit 21 please page 19 no excuse me page 18 exhibit 21 page 18 actually before we get there let me just ask you a general question would you agree with me that MVP's Vermont block of business should stand on its own and that the New York and Vermont block should be independently sustainable? Yes I do. Thank you. So in your actual memo under there's a table in the middle and then there's the third paragraph would you read the first sentence please? It is slightly concerning that MVP has experienced an overall negative profit in the last few years and there was a significant decrease in the RBC in 2021. And then it's the fourth sentence that starts L&E notes can you read that sentence please? Yes L&E notes that it is not sustainable to have long term negative profits and therefore a higher CTR could be justified. What do you mean by not sustainable? Not sustainable means that it cannot continue indefinitely or something will need to change. Would you agree with me in your actuarial opinion that regional not-for-profit plans like MVP need to remain profitable in order to serve the communities we live in? Can you restate the question? Sure. You just testified before looking at the sentence above that it's not sustainable to have long term negative profits correct? And so would you agree that companies like I'm too excited to catch that Mr. Carnegie. Didn't catch the response or the question? The response. The answer to the question. Let me just say it again. Well I guess I believe the answer is that I'm not going to say yes or no because I don't remember if I was supposed to say yes or no here but I think that what you're trying to ask is shouldn't a company need to be profitable to contribute to their communities and I think yes but they don't need to be overly profitable just struggling with the question a little bit they do need to be profitable they need to make some sort of they don't need to make money they're not for profit they need to have preserves to cover unintended losses sorry. It needs to be sustainable over the long term correct? Correct yes. Thank you and that's all the more important with only two health insurance carriers on the exchange in Vermont to serve the Vermont community correct? Would you go to exhibit 46 please? Okay I'm there. Thank you and your testimony on this this morning but the second column do you see the MVP proposed CTR column do you see that? Yes. And this year we're requesting 1.5% Yes. And you found that in your actuarial opinion to fall within a reasonable range of 0.5 to 3% correct? That's correct. And in column 6 do you see column 6 and do you see losses is it called losses or the MVP I counted the I had it written down but I do don't have that so yes the column for losses do you see that? Yes. And you see after you degree 2020 was the year of COVID correct? Perfect. So after that do you see a pattern of losses over the past several years? Yes. So if you were running a business with consecutive losses like that over several years would you be very concerned? Yes. You're a principal at L&E correct? Yes. You're an owner of a small business correct? It's true yes. And if L&E had substantial losses for two or three years running that would be very concerning wouldn't it? Yes it would. If they approached double digits each year for three years double digit losses that would be very concerning correct? Yes it would. Where your costs of doing business exceed the money you take in and that percentage difference approaches double digits for three years that's very concerning isn't it? Yes. Would you go to actually I guess we're still on it exhibit 46 and go to look at columns three and four please three and four that's the I tell you which ones the overall cuts proposed by L&E and then additional overall cuts by the board you see that? Yes. Would you agree with me that if the board cuts beyond your recommendations this year in 2024 2024 filing recommendations that increases the risk that 2024 will result in losses for the fourth year straight. It depends on the magnitude of the cut. Thank you. Let's exhibit 21 please and let's go to page 19 and the first bullet relates to the hospital budgets correct? Yes. And you would agree with me that MVP you would agree with MVP that any new information regarding hospital hospital budgets that becomes available it should be considered correct? Yes. And the closer to the actual approved budget the better correct? Correct. Would you please go to page 8 of the exhibit and you'll see there's a section there's two headings for COVID testing and then COVID vaccinations do you see that? Yes. And for COVID testing MVP reduced its rate by .04% correct? Correct. And L&E found that reasonable and appropriate correct? That MVP assumed a 10% reduction in COVID testing utilization that was a reasonable assumption correct? Yes. And that MVP did not similarly reduce utilization estimates for treatments and visits testing is more elected than those two categories correct? Correct. And on the COVID vaccinations a plus .3 that's the next one. I'm happy with me. Yes. And MVP had an increase of .3 over last year and you found that reasonable and appropriate correct? That's correct yes. And that's based on the assumption in part that commercial payers will be responsible for paying the full ingredient costs for vaccines correct? Correct. Yes. And that increases the payout and that's largely because no more federal funds are available right? That's correct yes. And then on administrative costs if you please we go to page 14 Okay. And to see at the very bottom there's a section 10 changes in administrative costs do you see that? Yes. And you referenced there in the second sentence the overall rate impact is a decrease of .6%. Yes that's correct. And then you go a couple of pages later to page 16 to the end of this section and would you read the last sentence please? Melanie considers the assumed 2024 administrative cost to be reasonable and appropriate. So in page 15 we talked some about MVP's expenses and then excuse me on 15 and then into 16 you talk about some carrier nationwide data. Would you explain that work that you did on the nationwide data and what you looked at at MVP please? Sure. CMS publishes a public use file there was known as a PUF each year with all of the data from the URT which is the federal template that all carriers are required to file with their individual and small group rate filings. We took that PUF which outlines what the I mean all of the assumptions are included on there but we looked into the administrative costs we looked at it as a percent of premium as well as a PMPM. So among all and we just combined it for individual and small group for this purpose and plotted where MVP was relative to all the other carriers submitting one I think caveat of the PUF is that it only includes federally facilitated states information so state based exchanges are not included such as Vermont but we know Vermont from the filing so just a note it's not everyone in the country but it's majority. Thank you and then if you go to page 16 please below the table can you read that paragraph that starts among individual. Yes. Among individual and small group carriers nationwide these figures are in the 10th percentile on a PMPM basis and on a second percentile as a percentage of premium that is MVP has atypically low administrative costs despite not being a very large health plan it therefore appears that MVP manage and limits administrative costs better than the typical health plan nationally. So that's a pretty positive statement from LNE about MVP's management of administrative costs wouldn't you say. Yes. Still on 21 let's go to CTR let me know when you're there. I am there. This happened last year and I just want to be clear on it I went through it with Chris and I think that he added clarity and last year you added clarity as well and it's just there's some semantics and uses of words. So first I just want to get that out of the way so we can align the numerical references that MVP makes with the numerical references of LNE so you would agree with the MVP seeking a 1.5% CTR correct? Maybe. The reason we have it as a 1.8 CTR is because as noted originally and the very top of our report we equate everything to the URT and the URT this is the line in which it sits so just sure they're asking for 1.5 for that particular line where ours also sits 1.5. Sure. So let me ask it a different way just to MVP has 0.3 associated with bad debt and 1.5 associated with what they call CTR correct? Yes, that's correct. So in this breakdown of contribution to reserves there are places where you say risk margin but to align it you're talking about MVP's 1.5 Yes, that's correct. Appreciate that. If you would go to let's see go to page 18 the first paragraph please. Okay. This is the reasonable check that LNE has done for the last several years correct? Correct. So would you read the last sentence please? MVP's filed based CTR? Yes, that one. No? Is that the right location? Yes, please. Okay. MVP's filed based CTR of 1.5% would place it at around the 23rd percentile for all QHP carriers and the 0.3 margin for bad debt in the individual market increases this to the 26th percentile. So as to CTR as you described there MVP's CTR CTR is very conservative would you agree? Yes. And in the second sentence it's the second to last sentence there's a referenced well why don't you sorry I'm trying to do this in a way that's not confusing yet the sentence that starts the mode would you please read that sentence? Yes. The mode is between 2% and 3% and the premium weighted average CTR for all carriers was filed as 2.8%. So compared to MVP's 1.5 again MVP's CTR is very conservative would you agree? Yes conservative meaning lower then. 17 please and you see the table at the bottom historical risk margin do you see that? Yes. And that shows what the board ordered versus the actual correct? Yes. And as an actuary does that discrepancy between the two numbers give you concern? Yes it is larger than would make me feel comfortable. You would want those numbers ideally as an actuary to align correct? Yeah I think alignment is a little bit up to optimistic but definitely over a period of time would be much closer yes. Thank you. And then if you would go to exhibit 20 please let me know when you're there. I'm in there. And this is Elene's response to the board's request for some information correct? Yes. And as I understand it you're not providing an expert opinion on affordability in this response correct? No we are providing information that was requested. We're providing some data to answer the board's factual questions correct? Correct. And it's for the board ultimately to determine what affordability is and whether something's affordable here under the statute right? Yes that's correct. And I presume you feel the data that you provided is accurate and reliable? Yes. Thank you. And then just a follow up if you go to exhibit 49 please I got confused and it wasn't because of your testimony it's me I'm going to take the credit for this. I was trying to understand when Laura asked you the final numbers wait till you're to the exhibit. Fine. Honest. I'm on exhibit 49. So I wrote down what the two of you discussed that you ended up at 11.6 for individual in 11.8 for small group and where I got lost was does that include the CSR? Does it not? Does that include hospital budgets? Does it not? I wonder if you could look at this table and just better explain the components of what's included and not included in your 11.6 and your 11.8 please. Sure. I was quoting from exhibit 45 where I said 11.6 so 11.6 includes CSR but does not include updated hospital budgets. So it is in alignment with adjusted for agreed changes from L&E plus CSR for individual and then that plus CSR on that second row you're adding a plus a 0.4 is that correct for CSR to individual? Yes. Which comes from exhibit 45 which says 0.3 but I'm sure it's a rounding issue. It's the 0.3 and then there's the 0.1 for the updated risk adjustment right? That's correct. Yes. Yes, that's correct. Thank you very much. I have no further questions. Questions from the healthcare advocate? Thank you. Hi Ms. Leigh. I have a few questions. I'm going to the normal stuff. I'm going to try to guide you. I'll probably mess up. You'll let me know that I messed up and I'll rephrase it. We haven't interacted for 10 years but I did get a notice during this hearing that I just had on July 1 I had my 7 year anniversary at the Vermont legal aid. So we've been doing this for 7 years granted up in lurking in the background. Is it okay if I call you Jackie in the area? Yes, please. So I just want to ask you to first get into exactly how you evaluate MVP's methods. So my first question is did MVP use a match pair method when it was looking or generating medical trend? No, they did not. So how many different kind of professionally accepted methods are there to generate medical trend roughly? Limitless. It can vary based on many factors. The age of the block, the volatility of the block, the actuaries performing the work and what they enjoy doing. The time that they have to spend the data that they have available to them. So there's a lot of factors that impact. I personally have never done a matched population. But Blue Cross does that. Fair enough. So this next question is a bit of a mouthful. I've tried to break it into two questions as you were talking. So hopefully less of a mouthful than it was originally. So when you evaluate a particular method to develop medical trend, is it the quote unquote best method compared to other professionally accepted methods? If you say something is actually reasonable, is it because they use the best method or is it just a professionally acceptable method? I would say it's more of a professionally acceptable method. We also do our own independent review. We definitely have limitations on the review that we're able to do because we don't have all of the data sometimes. We try to ask for it, but we do have limitations given our role. But we will do a general review. The other issue is depending on what type of trend we're setting. Retrospective is when you get data and look backwards. That may not be the most appropriate in all circumstances, but it's another data point and that's kind of what I would say is there are a lot of methods and it is in the best interest of somebody doing pricing to look at many of the methods available to them and many different slices of the data, meaning do you look at all medical combined? Do you look at inpatient, outpatient positions separately? And then you use all of those data points to project whatever trend it is you're trying to set. Okay, and so does is there a professionally best method? Like I'm thinking there moments say in education research, there was a moment when everyone was using multi-level modeling and that was like the method, the gold standard. And I'm just wondering is there a gold standard in actuarial science for medical trend? I would say no. Again, I think there's a huge variable here, which is data availability that doesn't allow for their beat to be a gold standard because everybody is so different in the size in which you can look at and, you know, as an actuary as much as you want access to all types of data, you may not be able to because it's not in your data warehouse, etc. Additionally, big changes in population could hurt a trend study for that. So, unfortunately no, but, you know, regression as you look across the two filings, you have very different, you have regressions, you have this matched population, you have an L&E study that was done a long time ago. I've often quoted industry studies when doing my own pricing. So unfortunately there's not really a gold standard. It's highly variable in how it's performed. That's really helpful and, you know, I have very little insight into that specific world, so it's good to hear that I wasn't losing it. So I'm going to switch gears and ask you some questions about specific elements of the MVPs rate. Just so we have a roadmap of where I'm going to go, we're going to start with admin costs and then we're going to talk about pharmacy trend and lastly about contribution to reserve so abbreviated CTR. So let's turn to exhibit 21, which is the individual group memo or opinion and we're going to look at, so that starts on the bottom of page 14, but we're actually going to go a little further into this section to page 16. Let me know when you're there. I'm on page 16. Awesome. So I just want to probe or understand a little better the visualizations of the distribution of admin costs. So you looked at the QHP carrier subject to the caveats you talked about and you just mapped the distribution and you figured out where MVP fell, is that correct? Yes. Okay. As if they were a data point within the dataset. And so when you make the statement that it appears that MVP manages and limits admin costs better than the typical health plan actually. So is that just based on like the empirical fact of where it falls in the distribution or did you actually look at MVP's practices? I would say where it falls on the graph. Okay. And so do actuaries for some books, books of business so in health insurance do they say look at benchmarks the algorithms for admin costs like when they're comparing admin costs? I mean I think we look at benchmarks I mean that's what this is. And in terms of assessing the efficiency of the individual data points in that distribution that's not something that's done or you did. No. I am going to switch over to pharmacy trend which starts at the bottom of page 6 but we're going to go to page 7. Let me know when you get there. Okay I'm on page 7. Awesome. So MVP's PBM is the source of the underlined data used to calculate pharmacy trend correct? Yep. So did you do any evaluation of how the financial interest of the data provider might bias the data provided? Or might not bias the data provided? We did not. Okay. And did you look at pharmacy utilization data to determine whether the drugs that are being used are going to play or is that just something you said the PBM does? I do not look at that. I'm not sure who is responsible for that. I would like to think the PBM knows but I'm not sure. It's outside of RV. We are cruising Jackie. Last topic and it's going to be about CTR. So would you turn to page 17? Okay. I'm there. So you did some analysis and came up with a reasonable range, right? Correct. And that range is 0.5 to 3%. Correct? Correct. Okay. I'm going to turn to page 18. So would you read the last sentence of item 12? So on page 17 and item 12 that starts with additionally, Eleni believes. Additionally Eleni recommends that one? Yeah. Additionally Eleni recommends that any solvency analysis performed by the Department of Financial Regulation DFR be considered. Okay. So switching gears a little when we're talking about CTR. So other than looking at the CTR amounts in the ACA filings that are in that puff. Does Eleni do any financial analysis of MVP's request or is it just again this observation of where it falls in the distribution? Let's say an observation of where it falls in the distribution. We also have some commentary about the RBC so we look at the RBC ratio over time but we note it as we note that there's a drop from 2020 to 2021 but we don't dig into why or drivers it's just something to be noted because we feel that that is the DFR's role to dive into those particular drivers and not ours which is why we reference DFR. Okay. So I think based on that answer I know the answer to the next few questions but I'm going to ask anyway. So you mentioned that you looked at their 359 carriers in that puff. Did you look at that each one to look at whether their CTR request was reasonable in the first place? No. Like do a financial analysis? No. No. Yeah. And could like, so that's nationally so I'm just guessing there are a whole bunch of states and every state has different policy requirements and could that, I mean is that true? Yeah. I would say that the the puff includes the final submitted URT's so they did I mean as part of the ACA you're required to have an effective rate review program but as we know in Vermont that it's different here than it is in other places and certain states are more stringent on what they look at and what they focus on but they are reviewed to some degree of reasonableness but as you can see that they range from a minus 24 percent to a plus nine I would give in all the time in the world and somebody paying me I would love to look into minus 24 right? Yeah. Who decided that was a good idea? But we don't know from the puff let's say like the minus 24 like their RBC could have been a thousand like we just don't know. Right. RBC is not actually a on the URT the only thing that's on the URT is the CTR that they file so you would have to pull the annual financial statements to retrieve the RBC and then match them up and it would be a large exercise. Yeah. Okay. So we're going to switch to the RBC chart. Yeah. So on page 18 do you see the table that is labeled historical RBC chart for ratio? Yeah. Okay. And so then between 2020 and 2022 it's saying that MVPs RBC dropped 60 .1 percentage points, correct? Sure. If you did that right. I'm counting on you to do the math Jack. I pulled out a calculator earlier. So you called that drop of 60.1 percentage points slightly concerning, right? Lightly concerning, yes. Okay. I want to understand a little bit more what L&E means by slightly concerning. And so heads up. Again, I'm going to, I suppose be asking you some questions that require you to do some arithmetic in your head, but it will be simple arithmetic, I think. Okay. So let's add 37 points 369.3 which was MVPs RBC in 2022 and that's 406.3, correct? It is. Okay. And then if we take the difference between MVPs 2020 RBC which is 429.4 minus that 406.3 which comes to a decline of 23.1, correct? Yes. Would a drop of 23.1 percent be less concerning to MVP? I mean to L&E, I'm sorry. I would say it depends on what the starting number is, if it's the 429 down 23. It would be something to look at. I know that we would have been so powerful to say a significant decrease. I would just say we would have called it a decrease because fluctuation in RBC is normal and I would call that more of a fluctuation but on the other hand if they were sitting at the 350 and went down 20 that would start to be I would be more concerned because the starting point is lower. That makes sense. So just because I want to try to put something in real dollar terms let's try to do that with that 37 points. So would you turn to exhibit 25 on page 47? Let me know when you're there. Exhibit 5 which is the 5. Exhibit 25. 25. Yeah, sorry. And you're looking at the 5-year historical for 2022? Yeah. On the annual statement. Okay. Okay. So MPP's 2022 authorized control level was 111.992 and some change. Is that correct? 296. 296. I guess I'm C961. Yeah. No, that was my bad typo. So using the MPP's 2022 authorized control level let's put that see how much that 37 points is worth. Can you do that math real quick Jackie please? I mean do we are we assuming that the total capital didn't change? Correct. So I just want to know how many, what's the dollar value of those 37 points using the authorized control level? Okay. So minus 37. I'm using my phone if that's okay. More efficient than an advocate. No, okay. Okay. So you want it to go from like the 369 up to the 406? Because that was the original math we did. So you did, we were talking about and we were saying it's a decline of 37 RBC points. And I'm trying to put in dollar values how much that 37 RBC points is worth. Okay. Sorry. I didn't know I'd be doing algebra right now. So 10 million. Hold on. Let me just do the final step. 12.5 million ish. Is that what you came up with? So it would just be 37 million divided by 111 million .961, right? Sure. I came up with a higher number, but sure, at least 12 million. Okay. That's all my questions for you Jackie. Thanks. No problem. I didn't want to interrupt you there, but could you just clarify what page of exhibit 25 we were talking about with the authorized control level? Sure. Page 47 the ACL is item or line number 15. Okay. Move to board questions starting with board member Lunge. Thank you. Hi Jackie. Nice to see you. Nice to see you too Robin. I have a couple questions about your memo. Okay. So if we could go to exhibit 21 starting page 7 specifically around pharmacy trends. Yes. So in your report you provide some explanation of of look well so in your report you have some historical allowed trends on page 7. Is that right? Yes. And your suggestion is that 2020 and 2022 were outlier years and that those outlier years should be mitigated against in any analysis of trend. Is that an accurate reflection of your report? Yes. And so in your report you also give some 4 averages excluding those years which include trend levels of 8.1 and 7.1. Is that right? Yes. Yes. Excluding 2020 and 2022. Correct. Yes. So when looking at a pharmacy trend as you talked about with Mr. Scholdeis there can be different ways to come up with a reasonable trend level. Is that right? Yes. That's correct. Great. Thank you. I also had a question in exhibit 22 on page 12. So on page 12 in your discussion of administrative costs you indicate that in looking at admin in 2022 and I'm going to read this to you please confirm whether I'm reading it correctly MVP began managing and billing payment processing functions. Is that right? According to them yes. That's right. Yeah. Do you understand that they began billing and payment processing functions for the small group in 2022? And if you don't know that's fine to say you don't know. Yeah. I don't. That's okay. Thank you. Thank you. I think that is all my questions for you Jackie. Thank you. Thanks Robin. Hi Jackie. How are you? Good. Hi Jess. Fancy meeting you here. My question for you just a couple of quick questions. It's on exhibit 21 but it's also in your exhibit 22 on your analysis on page 18 which has been discussed and discussed around the CTR the analysis where you reference the filed CTR rates for the 359 carriers on the individual and small group market. Yeah. So the analysis you did was on the filed rates and I'm wondering if you also did an analysis or if an analysis is available on the approved CTR rates presuming that they would be lower than the filed rates in states that would downward adjust those CTRs. Yeah. I believe so it says in 2023 which is I believe that's what we're talking about so that would be what was filed. We can the final I don't believe that they do an interim so from what I understand this is what I said when Eric and I were talking is that this is the final number that the states approved and I know it says filed there which I guess that's my confusion with the filed and approved right at least in the state of Vermont is different and so if it's totally different in other states I guess what I was wondering was what is the mode and what is the average of the approved versus the filed. So we have only showed you here the puff is produced after they have been approved so we've only shown you the filed and approved so we'll make a note to make that more crystal clear next time. That's helpful. Okay thank you. And so and the Eleni in that's on that same page 18 the last sentence or the last sentence of the second paragraph which has been cited multiple times Eleni believes that a CTR between 0.5 and 3 would be reasonable. Yes. So that means that a CTR of 1 would be reasonable according to Eleni. Correct. And a CTR of 0.5 would also be considered reasonable by Eleni. Yeah. Okay. Yes. My last question I should have two more questions. MVP estimated a 10% reduction in COVID testing costs once that cost sharing was instituted and I'm just wondering given the pandemics has subsided a bit and there's a plethora of these over the counter tests is there any evidence to support a higher reduction than 10% in that COVID testing line that would also be considered actually reasonable 10% to me seemed low. So I'm just wondering is there any evidence to support a higher reduction in that cost line once the cost sharing is instituted and given the fact that we have all of these over-the-counter tests that at least in my anecdotal world people are using not going and getting PCR lab tests anymore. Yeah. I would say that I'm not sure how much of the actual basis there is for the 10 either so I think that if MVP had proposed COVID testing or 5% either one I think we would have come to a similar agreement with them that it's reasonable because there really isn't a lot of data to support that assumption and just more anecdotal that you have referenced. Okay. Thank you. And if it turns out I don't know if you heard my earlier line of questioning around the vaccines but the Vermont vaccine programs will include COVID vaccines in 2024 would you recommend removing the increase associated with the increased ingredient costs for vaccines from the filing? Yes, I agree. If the vaccination program is covering it then it should be removed from here otherwise it would be double counted and charged twice. Okay. Thank you. Those are my questions. Yes. We'll remember them. Hey Jackie. Hey Dave. I just have a couple of things. I'm just going to stick with the COVID testing because I was going to ask a similar question and maybe I should have asked it of Chris Pontiff but do you you don't know where the 10% came from then it sounds like it's possible I could go look back at because they did provide a good amount of support for the COVID assumptions so I have to go look to really quote what you have. Yeah, I can't remember what it was either and I was curious if you remember whether or not they had a mix of whether or not these are inpatient tests that were done on inpatients versus outpatients but my understanding is that until recently most hospitals required testing on every admitted patient but that has gone away and if most outpatient testing and then most inpatient testing is then I mean inpatient testing has been reduced substantially so maybe I can take a dig through that but are you aware of any of the if this is inpatient or outpatient at all? No, I think that would be a better question for Chris. All right, that's all over Chris. The other question I just had for you was on the admittance on page 16 of 21 the admin cost distribution you said that the Vermont carriers are not in the database that you're getting the data from are you, how confident are you that the way you are defining admin costs is the same as the way the database is defining admin costs? We have defined admin so even though Vermont's not in there they're still required, the carriers are still required to submit the URT which is a federal template so it is 100% coming from the same cell as all the other carriers and that is defined as the that is defined as the in the URT instructions what's supposed to be there and I guess one thing to note to we don't as kind of just touched on we have the filed and approved amounts for 2023 we have put our kind of graft where MVP's 2024 figure would be so there is also a a gap there for you. Oh so these aren't sort of shifted in any way for like an expected okay. No so that should be taken into account however if I were to do something along those lines especially for the PMPM I would trend them forward which would move everybody over and kind of either keep it still in this same percentile or even move it closer to the left or zero so but that would be an arbitrary increase we certainly wouldn't project everybody's admin. I understand that. Thanks. Thanks. I had just actually a question Jackie if I get interjected here this is around the graphing of admin expenses based on the PUFF Yes. So I'm on exhibit 21 page 15 bottom paragraph first sentence it refers to non-benefit expenses and I'm just wondering if you could clarify our admin and non-benefit expenses the same Generally speaking yes yes you have benefit expenses which are like your claims and then you have non-benefit expenses so they would be all other pieces I would say that non-benefit expenses could also include things outside of admin such as CTR profit taxes and fees so admin is a subset of that in the ORT. Okay so the graphing on page 16 is the admin component of non-benefit expenses? That's correct yes. Okay thank you. Chair Foster do you have questions? Mostly just for clarification by understanding Page 2 of exhibit 21 the chart of the plan type and the percent of membership do you know Miss Lee if there's any comparison data available for us for what how other states break out in terms of the percent of membership at the different metal levels? There are some states that produce this information. I believe that this is I think you can possibly get it at the metal tier by state but you can't so we have a breakout of silver loaded versus reflective that is harder to get at is who basically who buys the CSR plan if you will who's on exchange that one's more difficult. I do believe that some states for instance I do some work in Nevada they produce something similar to this that you can look at but across the board like from KFF if you will you can get the it's usually two years dated because again the URT is the best source so right now 2023 projected enrollment is out there which it's not reliable but you have 2021 actuals and you would have that by metal tier but you wouldn't have it by CSR plan so you'd have silver but not 73, 87, 94. That would be one of the first similarities I've heard between Nevada and Vermont. They have a really rigorous rate review program number two for you. I'm sorry. On page 5 of 21 under medical unit cost trend. Yes. As MVP computed it's a loud trend as a weighted average of 2023 medical claim unit cost trends for various types of care settings. What is a unit cost trend? I want to make sure I understand exactly what that means. That is the cost for a service. So trend is comprised of how much it costs and how many times you're using it. So if an MRI goes from $100 which is probably too low to $120 it's a 20% unit cost increase. Okay. But how many times people use it would be your utilization. Okay. And both of those are factored in to come up with the medical cost trend here. The medical trend. You can say cost but I don't want to confuse you. Okay. So medical trend is unit cost and utilization. So that's the two components we have on top of each other. The combination of those is your medical trend and sometimes we'll say medical cost trend but hopefully we take all that out because that's confusing. Okay. So we have the overall unit cost medical trend of 4.6 includes 5.1% for GMCB regulated hospitals and then 3.8 for others and I might just be misconception all of this but the hospitals have requested 10, 12, 15% whatever the rates are. What's the delta between those rates and this number? What are the other things that are between those two numbers? So when the hospitals have requested 12, 13% as you've just said we're talking about bullet point number one only and this is for all service categories inpatient, outpatient, physician and other. So physicians are not getting those similar increases so that would be part of it and it'd be a weighted average of all of those plus a weighted average of all of the facilities. So UVM is one of your biggest so it would have a pretty high utilization there but it's also so when you're looking at this it would be how much are people utilizing your stop how much are MVP beneficiaries using the particular facilities and the particular services? Right. You said UVM would be more significantly sway these numbers because of the volume of people that would be going there. Yes, yes I don't have it memorized and it is in the confidential material but how much it is but yes however many people and dollars are spent with UVM if that's much higher then their rate change would be higher. Then going down to the second bullet in that same section it says approximately 87% of medical services utilized or administered by providers not subject to the GMCB hospital budget review medical services utilized is this based on what is that based on is it based on cost or like dollar value or yeah dollar value yes so the dollar value for MVP customers 63% of it is spent at Vermont hospitals correct yes um then just exhibit 20 okay oh yes I'm there just um page 4 so after 2021 we have the subsidies which is why these percentages of income are going down while rates are going up but the rates have been going up even after the subsidies have come on right so in 2022-2023-2024 but each of these lines remains relatively static that's trying to get a sense of why if the rates are going up is it remain static even after the subsidies are available um so that's coming as because we'll first off the subsidy is based on the lowest cost silver plan um so as the lowest cost silver plan also increases at the same exact rate that would then mean that the subsidy is increasing at the same rate therefore your rate is not changing um and that is especially true for um all of these folks um I know for bronze it's not not great to look at because it it is such a low premium but you can see this a little bit the other in the silver um but that's a bronze too there we go second lowest silver so there's oh interdigital family right um if you scroll down to let's be a little I don't really like the platinum we'll stick with gold which is on page 6 you will see that it is increasing um after 2023 or really 2022 into 2023 it's not flat and that's because the gold plans are increasing at a higher rate than the second lowest silver plan did um and the other thing that's I believe this is relative okay yeah yeah I'll stop there I think that that's helpful enough but yeah that's why there is an increase here but back on silver and bronze uh because subsidies are being subsidy dollars can cover both of those that's why it's flat okay thank you that's helpful um I don't have any other questions thank you very much someone Miss Belibow any redirect uh no I do not okay thank you miss I'll turn on the first name first name bandwagon here um yep why not I I think that would be a good time to do the executive session that seems like is appropriate um I don't believe I heard any questions for Jackie about the confidential portions of the report does anybody have any questions for Jackie in an executive session no so I don't think so sorry sorry Mike I needed to think a minute I don't think so but um I may depending on the answers just from Mr. Pontiff I may have some clarifying questions for Jackie but it would it would only depend it would depend on how that goes I see okay um and I believe all the questions for Mr. Pontiff were cross questions Gary did you have any direct that related to the confidential information no it just would be any redirect following up on board questions but I don't think I'll have much okay um so let's so assuming the board wants to go into executive session um we can go through the motions to do that now um take a short break come back and finish with Mr. Fisher's testimony in closing arguments um so the procedure for going into executive session just um general counsel oh yes great but there was uh Mr. Long asked questions of Mr. Lucier there's a possibility he might need to do a follow up after we hear uh from L&E I don't know how you want to time that you want to do it after executive session um I I'll leave that to you um if you have any questions for Mr. Lucier it'd probably be best to just get those out of the way now and let him go so Brian do you have anything for the screen just just two quick questions okay Jesse are you still with us yes I am okay um so just to remind you you're still under oath um and Mr. Long has a few more questions for you go ahead uh again Jesse uh you just heard Jackie Lee's testimony correct correct and I believe we left off your testimony that you agree that the rates as testified to by Mr. Ponte today were not negatively impact solvency contingent on what you heard from Jackie Lee is that right correct and has your opinion on solvency changed based on what you heard my opinion on solvency has not changed thank you that's all Eric any any additional questions on that no questions from us any questions from the board members on that okay thank you Jesse for for being with us today yep thanks mm all right so um just want to talk a little bit about the procedure for going into an executive session um we do it so infrequently that it feels like it's new every time um so emotion to go into executive session has to indicate the nature of the business of the executive session um the open meeting law uh says that the board can go into executive session to consider records that are exempt from disclosure under the public records act provided that discussion of the exempt record shall not itself permit an extension of the executive session to the general subject to which the record pertains um and then we also have our rate review statute which uh is similar but broader so our rate review statute says that notwithstanding the open meeting law the board may examine and discuss confidential information outside a public hearing or meeting so all of the material in the binders that has been marked as confidential has already been reviewed and determined to be exempt from public review public inspection disclosure under the public records act so you can go into executive session to question witnesses about that material um and really you need to go into executive session to discuss that material since we have a duty under the rules to protect that um and then under the rate review statute uh you can also examine confidential information generally um outside of a open hearing or meeting so including an executive session so if you have questions that call for confidential information a number of those have already been kind of identified I think um you know typical subjects are provider contract negotiations pricing information things that we typically treat as trade secret information you can ask those kinds of questions in an executive session as well um there was one line of inquiry that um fell the typical uh contract negotiations pricing which I kind of want to hear a little bit more about from Mr. Pontiff in the executive session but it seemed to be around like primary care uh questioning around primary care and I'm not not totally sure that is appropriate for an executive session but um we can have that information there um so so um any questions about that from the board members okay so I think the motion would be if anyone would like to make it to go into executive session to consider confidential records and information um and there would need to be a two-thirds vote in favor I will move that the board go into executive session to discuss uh confidential information and uh confidential documents except from the public records act second any discussion from the board okay on those in favor of the motion please signify by saying aye aye any opposed okay um Mike do we need to clarify who is going into executive session specifically yeah and a couple things we need to clarify at first I wanted to just confirm with Ms. Cass sorry Ms. Haaland um would it be possible to get this portion of the transcript portion of the hearing transcribed separately yes of course yes that's on top okay um yeah in terms of participants um it would be um the parties um their representatives the board board staff um um the witnesses um I think Ellen need needs to be there as well um am I missing anybody sorry again we do this so infrequently I'm assuming you're including the HCA and the parties yes HCA parties um board members Mr. Pontiff Lewis and Ellis representatives um board staff and I think that's it we also have Julia Dore from MVP if she could join us as well yeah okay um I want to say this shouldn't take longer than it'd be good to give a time frame for folks who maybe are on the line but can't join the executive session so uh you know thinking try to be out by four o'clock but we can adjust that as we go um no I don't think that's likely uh quarter after four then it'd be possible to get a 10 minute break before we switch over to Cassidy's shaking nodding her head so yes we maybe keep it to five minutes because I think we're trying to adjourn by five is that right fine with me yeah okay so I think we're ready um why don't we take a five minute break and then I'll call into the uh executive session line at um 3046 can I ask one question just so I don't screw this up do we leave this on our screen and then then go into the executive session screen as well do we just close this out and go into executive session I would close this out go into executive session uh we will have people on this line to you know put up a notice that we expect to you know return to this hearing at this time um but it's best not to have that open in case things don't get muted and you know great thank you and um can my backup recorder be included as well it ends in nine seven two seven yes where do we get the link for the new session you should have received a invite for it already just make sure you're on the list don't see you're on the list okay um I can forward this to you my apologies no I can't forward that to you um Kristen or Perez on the line and Mike you can't you weren't able to forward it from your this is Susan speaking from your email let me try or Tara might be able to do it easier I'm not able to forward it no okay get it to Tara are you able to do that I am not I've just asked Kristen to okay general counsel once you get this squared away I have one other issue to raise with you well this may take a minute so go ahead well there were a number of questions from the board which Mr. Pontiff indicated uh well I need to check with uh someone else and so we have someone else government affairs person Jordan Estee who we're going to bring into executive session I think that would help the board I know he wasn't disclosed but I think Mr. Pontiff is reacting to some of the questions that wanted to try to give the board more information if we can by presuming there'd be no objection to that and these are questions that called for confidential information uh I I believe so yes it would be limited to some of the questions where the board members said we would go into executive session and ask you and I could make a proffer I know Chris knows some things but not everything um and this is a government affairs person might be able to shed light Eric or Charlie any objection from the HCA to that I think they may have already gone on the break well I apologize we can deal with it when I get back um what I'll do is uh I'll bring him on and then if folks don't want him there we can just kick him out at the outset thank you for your consideration okay yeah why don't we so to give you all the break that uh mentioned why don't we call into the executive session line at 350 Cassidy if you don't have the link by then you should have the link by then okay yeah I just sent you an email Cassidy hopefully you received it okay one moment yes and will that include the phone number as well for me to call in with my backup recorder oh perfect I see it there thank you so much absolutely thank you for your consideration hearing officer I'll see y'all in a five thank you okay so we are back on the public portion of the hearing after having had a brief executive session or an hour long executive session um and uh Miss Bellovo we know she had some questions for Mr. Pontiff and I don't I just wanted to check in with you Laura on whether you think that that could be done through a post hearing interrogatory given the time or whether we should spend a few minutes with that it could be done in a post hearing interrogatory but I think it would move the understanding of the issue forward if I could ask the questions now and then have clarifying uh questions and follow up okay is Mr. Pontiff still with us been a long day for you but I think Miss Bellovo has a few questions on the on the CSR issue that sounds like we should get done so um just to remind you again that you're still under oath um and go ahead with your questions Laura thank you thank you so much for letting me ask a few additional questions um if you could please turn to exhibit 21 and look at the table at the bottom of page 14 okay um and uh you say there uh a table that has um um Ellen's recommendation regarding CSR load yes could you could you please look at those numbers and delineate in some additional detail how Ellen's recommended silver CSR load result in a 0.4% impact to silver plans as you testified earlier today I may have misspoke so I appreciate you bringing that to my attention the silver plans would go up the silver plans would go up by this much by the delta between the two so between two and a half one and a half to two and a half percent um what I yes that's that's correct what what I stated earlier or misstated earlier was 0.4% I believe before MVP made the offsetting impact to the market um morbidity it was a 0.4% impact now it is a 0.3% impact so the offsetting amount hit on the rest of the plans decreased the overall rate by 0.1% so it doesn't translate to um 0.4 on just the silver all right thank you and uh to confirm what you're saying that uh you misspoke earlier do you did you make any new assumptions regarding morbidity or other values besides the silver load in your calculations yes we took we took ellenies uh recommended silver loads and we implemented them but then we also following the guidance we laid out in their memorandum um we reduced the index rate for the fact that um as ellenie points out here which MVP doesn't agree with but or doesn't generally agree with but is doing the full process in the way that I believe ellenie intended um the new CSR members will perform better than their AVs so we made a slight decrease to the index rate for that which is the result is that resulting 0.1% uh decrease so it is essentially it is it is a morbidity increase to the market it does raise the overall PMPMs but it is a market decrease relative to the silver member so if a CSR 94 member enters the market the assumption is that they will perform a little bit better than a 94 AV plan as ellenie um suggested in their memorandum all right uh thank you so much Gary any anything you'd like to supplement on this issue sorry you're on mute uh Mr. Pontiff how many hours you've been testifying uh nine eight and a half ever made any mistakes before your life yes thank you that's all I have right I think we can finally let you go uh at this point and uh Mr. Fisher are you ready to go yes could you please raise your right hand do you solemnly swear that the evidence you shall give relative to the cause now under consideration shall be the whole truth and nothing but the truth so I hope you got thank you you can go ahead uh thank you Mr. Hearing Officer and thank you board members and others um it's been a long day and I think I will be brief uh I am Mike Fisher I'm the chief health care advocate uh this is a position defined in state statute an office defined state statute um to be a public advocate on behalf of Vermonters um I don't know if anyone here knows but I think it's worth saying uh we run a helpline that's available to all Vermonters uh and a policy team that engages in activities like this one throughout state government I make today's comments from the perspective of supervising these activities over a number of years in his opening um balancing act I agree it's a great metaphor for the task in front of you the statutes provide for what I would say in a lay person's terms balancing the needs of the carrier and the financial challenges of Vermonters while improving access to care improving or maintaining access to care every year when I walk up to this task I'm reminded of a concept no one would call effort successful if the outcome of affordable as possible resulted in a solvent company but only a handful of Vermonters could afford the premiums know that the balancing act requires a recognition of the impact of this decision on Vermonters affordable as possible gives the Vermonter who faces who's forced to make an economic decision over a healthcare decision very little comfort brings me to um let me talk for a moment about the individual market no dispute the enhanced premium tax credits for 24 and 25 are real and substantial what will happen in 26 while the people who will the people in leadership be in the U.S. House and Senate and in the presidency when this decision is made about whether to extend this no one can reasonably make a prediction about that and further the old logic that politics makes it harder to take away a benefit that people have grown accustomed to doesn't give me very much comfort in this context any rate increase allowed for in this proceeding will become part of the base in future years what I'm trying to say here as much as I'd like it not to be the case we're not off the hook around concerns for the individual affordability in this decision for the small employers the the impact is much quicker small employers and their employees will feel will feel this decision next year and directly as an employee at Vermont legal aid I see the impact of annual rate increases in health insurance premiums on the non-profit sector and watch how at least from our perspective the challenge of continuing to provide service is challenged by these rate increases further there's a couple of great comments that came in your public comment process and I'm going to reference one or two of them one commenter said the filed insurance increase in the small group market are unsustainable for small businesses and their employees if our company has to shoulder such high increases we may cut our percentage of contribution for each employee making the individuals suffer economically most people in the small group already saw double digit rate increases last year another commenter said I want to make a comment about the CSR loading discussion I want to emphasize I think many people know it but I want to emphasize the purpose of this recommendation on CSR load was intended to provide services for small businesses for small businesses for small businesses for small businesses for small businesses on CSR load was intended to rise all boats I'm not sure if that's a good metaphor today given our weather or a bad one but any differential treatment between the carriers will put a drag on one carrier and their rate payers the goal was to give her monitors who get premium tax credits more buying power we have an opportunity to do this hopefully the board will apply the strategy available to it that is most effective at reaching that goal improved affordability in a uniform fashion so I'll go back to a high wire balancing act suggests a risk if we misstep who's going to fall would you join MVP here of course we don't want the carrier to fall but obviously we don't want Vermonters to fall either or to leave the metaphor from our perspective premium increases will price more people out of the ability to afford the care they need Vermonters are counting on us to minimize this when I look at the public comments together and combine it with what we hear from Vermonters every day at the helpline I land at the same question that Eric Schulte asked at the beginning of the day if all the segments of the proposed rate this year and previous years are reasonable how can the result be so unreasonable for so many Vermonters thank you Mr. Hearing Officer and thank you members of the board Thank you Mr. Fisher questions for Mr. Fisher No questions thank you Do any board members have questions for Mr. Fisher sorry I'll just go around Robin do you have any questions No Yes Dave No Chair Foster I do have one or two Mr. Fisher you reference pricing people out of the care they need Do you have information or data reports you can share with the board relating to that issue it's one that's obviously we're concerned about Mr. Chair we I would describe the data that comes to us through the helpline as more of a canary in the coal mine dynamic than a source of data that we can create numbers from amongst the set of Vermonters who are having affordability challenges and know to call my office and what percentage of them know to call the HCA I'm afraid the answer to that's relatively small so what I can say is that it's a regular call it's a regular occurrence where a Vermonter calls us and says I'm trying to figure out how to make it through this thing trying to figure out what plan to buy I'm trying to figure out whether it makes sense and after looking at the data and looking at the options they decide they are faced you know I'll put it that way put it the way I put it earlier the economic decision in front of them takes precedent over the healthcare decision in front of them and it's certainly something we've seen in public comment as well and heard in my travels speaking to the people but I think just for both parties one thing that would be helpful in balancing this high wire act is the best data and information we can get between these potential adverse consequences that we're trying to avoid as you can appreciate the board on both sides we don't want insurers to leave we don't want them to be insolvent and at the same time we don't want people avoiding care or delaying care or shifting down what metal level they're at because that has negative consequences too so just an open request that if there's information that helps us appreciate the risks and how real or likely they may be and to quantify them I know it's like a nearly impossible ask but it helps us on that I think it's very beneficial I think you can all appreciate we don't want any of these consequences I have nothing further and thank you very much Mr. Fisher thank you okay so I think that concludes the well no sorry I always missed this up Mr. Carnegie are there any additional witnesses you'd like to call no sir okay then are the parties ready to move to closing statements yes sir yes and I believe it's MVP goes first that's right well I just want to thank everybody thank everyone on the board and all the witnesses today for their time and attention I think that Chair Foster that last comment he made sums up the whole dilemma I only am responsible part of that dilemma you all get to deal with that balancing act and I don't envy you in the least I do think that we're all on the same page of wanting to make sure that Vermonters get the health care that they need and get the health insurance that they need any decision on a final rate by the board should of course take into consideration all the statutory criteria I'm sure that a reduction on one criterion does not result in a statutorily inadequate rate the board should consistently and reasonably exercise its discretion considering the hospital budget impacts this year based on the testimony today I would encourage the board to think through how we can get this chicken and egg problem but how we can get more information from the hospitals rather than the carriers having to make presumptions about their business to be helpful given the evidence presented the board should not cut MVPs proposed CTR below 1.5% in its regulatory role of making sure that Vermonters have the best health care and the best health insurance possible the board should not ignore MVPs three years of multi-million dollar losses the board should strive to avoid that outcome in 2024 I want to be clear on this because I think it may have been lost a little bit in the testimony today the way we presented this is not an RBC issue it's not an RBC issue if Kellogg's is selling lucky charms like gangbusters and cornflakes are losing money year after year it's prudent for Kellogg's to look at its cornflakes business and look at it independently as a business standing on its own that's our point so when you deliberate on this please remember that we weren't talking about RBC talking about cornflakes it was about this discreet Vermont business and you heard from both actuaries saying that you need to consider these rate filings and consider the Vermont business, the book of business standing on its own standing on its own it's been losing millions of dollars year in year out thank you very much for your time thank you Mr. Schulze sure so you know Vermont law is clear that the task before you isn't defined by a mathematical formula so in some states that might be the case so a valid rate is one could be one that's actually not inadequate and not excessive that's not the case here and Vermont law is unambiguous about that so as Mr. Carnegie alluded to you and Mr. Fisher did you have an exceedingly unenviable task of balancing the needs of your neighbors against actuarial estimates that's what the law demands consider MVP's rate proposals I see you keep just a few things in mind first has MVP proved by a preponderance of the evidence that the rates are affordable promote quality and promote access unless marketing language counts is sufficient evidence I do not think they have second actuaries have presented many estimates today all the estimates presented even if they are specific number points within an actuarially reasonable range which itself depends on the specific professionally acceptable method used to arrange within a range also remember that they are estimates perhaps are best guesses but they are estimates not facts we do have a few facts before us though we have the fact that a series of reasonable and appropriate actuarial assumptions results in the unreasonable outcome of far too heavy a burden being placed on our neighbors we have the fact that premium price growth has far outpaced wage growth and other economic indicators year after year most tragically we have the fact that our neighbors even if they can afford premiums can afford to access care I would like to leave you with three simple questions as you deliberate on this by me what other business increases prices by double digits for second year in a row instead of finding ways to achieve operational efficiencies what good is an adequate network of providers if many of our neighbors can afford to see the doctor lastly can Vermont ever achieve the triple aim if every year fewer of our neighbors can afford to see care thank you thank you so I heard a number of every year we issue a set of hearing follow up questions questions you know weren't able to be answered at the hearing we're going to do the same this year I've been trying to take notes and keep a list I hope you have as well hope to get that on the next couple of days certainly by the end of the week one thing I did hear that I just want to say out loud because it requires consultation with third parties is the question about whether the COVID vaccine for next years in the Vermont vaccine purchasing program like that issue for adults which I think requires some reaching out to VDH maybe Department of Health who runs that program so we will get a set of follow up questions out to MVP shortly and anything else from the parties before we move to public comment just housekeeping the briefing deadline is the same July 28 and the goal is to get transcripts to us by the 21st is that correct yes no additional questions from us okay so we do take public comment at the close of these hearings so if there is any member of the public who's with us who would like to provide a comment if you could please raise your hand or if you're on the phone take yourself off mute go ahead and do that seeing anyone so again if there are any members of the public who would like to give public comment on this filing or blue crosses individual sorry these filings or blue crosses individual and small group rate filings will be having a meeting on the afternoon of Monday July 24th for that purpose and with that I will turn it back to you Chair Foster to adjourn the meeting great just thanks to the parties and the witnesses this is my first rate review hearing extremely informative and professionally done so thank you and hearing Officer Barber really impressive work thank you for all you did for this and to all the rest of the rate review team so big thanks because I know it was a lot of long weekends and everything so thank you and with that I'll take a motion to adjourn if anyone has one and moved second all those in favor aye aye we are adjourned thank you have a nice day and Mr. Foster is there someone I could speak to about getting the verified spellings I can email that to Cassidy oh perfect do I have do you have my email address I do okay was that you that emailed me the executive session yes okay so I'll respond to that executive session email with my list and if there's anything that seems out of order doesn't make sense it could just because it's a very quick phonetic guess request so don't don't let it become an issue or take any time on it just let me know and I can refer back to my notes so I'll send you that list this afternoon great thank you very much thank you thank you for that y'all have a good night thank you thank you Cassidy you're great thank you my pleasure bye for now bye bye bye