STATE OF OKLAHOMA

1st Session of the 53rd Legislature (2011)

SENATE BILL 643	By:	Johnson (Constance)

AS INTRODUCED

An Act relating to health insurance rate review process; creating the Oklahoma Individual Market Rate Review Act; providing short title; defining terms; requiring insurers to submit changes in premium rates to the Insurance Commissioner; requiring the Commissioner to issue certain written findings; authorizing the Commissioner to determine if filing is complete; specifying that approved rates shall be guaranteed by the insurer for certain time; requiring the Commissioner to post the rate filing on the Insurance Department’s website; requiring the Commissioner to promulgate rules to establish the information required to be included in the rate filing; specifying information to be included in the rate filing; requiring an insurer to send certain written notice to affected policyholders; specifying form and content of the notice; requiring certain e-mail alert system to be made available by the Commissioner; requiring public comment period on the rate change and rate filing; specifying time periods for the comment period; specifying standards for rates; directing the Commissioner to disapprove a rate change under certain conditions; requiring the Commissioner to take certain factors into consideration when making the determination on the rates; requiring an insurer to pool certain experience until certain provision is fully in effect; requiring the Commissioner to provide written notice upon approval of a rate change; specifying form and content of the notice; specifying effective date for such rate change; requiring the Commissioner to hold a public hearing under certain conditions; directing the Commissioner to promulgate rules governing the hearings; requiring such hearings to be conducted by a hearing examiner; requiring Commissioner to provide notice of such hearing; specifying form and content of the notice; deeming certain documents and correspondence to be public records; authorizing the Commissioner to contract with certain actuaries or experts; requiring the position of Consumer Advocate within the Insurance Department; specifying duties of the Consumer Advocate; allowing certain persons to intervene in a proposed rate change; authorizing the awarding of certain fees and expenses to certain persons; specifying jurisdiction of certain review; providing codification; and providing an effective date.

BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1.     NEW LAW     A new section of law to be codified in the Oklahoma Statutes as Section 4420.1 of Title 36, unless there is created a duplication in numbering, reads as follows:
This act shall be known and may be cited as the “Oklahoma Individual Market Rate Review Act”.
SECTION 2.     NEW LAW     A new section of law to be codified in the Oklahoma Statutes as Section 4420.2 of Title 36, unless there is created a duplication in numbering, reads as follows:
As used in the Oklahoma Individual Market Rate Review Act:
1.  “Commissioner” means the Insurance Commissioner;
2.  “Department” means the Insurance Department; and
3.  “Insurer” means any entity subject to the insurance laws and regulations of this state, or subject to the jurisdiction of the Insurance Commissioner, that contracts or offers to contract to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services, including, without limitation, an insurance company offering accident and sickness insurance, a health maintenance organization, a nonprofit hospital service corporation, a nonprofit medical service corporation, a domestic insurance company that offers or provides health insurance coverage in the state and a foreign insurance company that offers or provides health insurance coverage in the state.
SECTION 3.     NEW LAW     A new section of law to be codified in the Oklahoma Statutes as Section 4420.3 of Title 36, unless there is created a duplication in numbering, reads as follows:
A.  Any insurer desiring to change premium rates on any policy form, contract, or certificate must submit electronically a rate filing request for approval with the Insurance Commissioner.  No premium rate or change to a premium rate shall be used unless approved by the Commissioner, and unless policyholders have received notice as required in Section 9 of this act.
B.  Within thirty (30) days of the close of the sixty-day public comment period required under Section 6 of this act, the Commissioner shall issue a written decision with findings on the considerations listed in Section 7 of this act, and any other considerations taken into account, to approve, modify, or disapprove the proposed rates.  If, however, a hearing on the proposed rate change is held under Section 10 of this act, the Commissioner may reasonably extend the time to issue a written decision with findings to approve, modify, or disapprove the proposed rate change to accommodate a hearing schedule.  Upon issuing the decision, the Commissioner shall post his or her decision on the Insurance Department’s website and provide written notice to the insurer of the decision.
C.  Failure to submit all of the information required or requested by the Commissioner under Section 5 of this act shall make the rate filing incomplete.  Within ten (10) days of receiving a rate filing for a proposed rate change, the Commissioner shall determine whether the filing is complete.  If the Commissioner determines that a filing is incomplete, the Commissioner shall notify the insurer in writing that the filing is deficient and give the insurer an opportunity to provide the missing information.
D.  Approved rates shall be guaranteed by the insurer, as to the policyholders affected by the rates, for a period of not less than twelve (12) months, or as an alternative to the insurer giving the guarantee, the approved rates may be applicable to all policyholders at one time if the insurer chooses to apply for that relief with respect to those policies no more frequently than once in any twelve-month period.
SECTION 4.     NEW LAW     A new section of law to be codified in the Oklahoma Statutes as Section 4420.4 of Title 36, unless there is created a duplication in numbering, reads as follows:
A.  Upon receipt of a rate filing requesting a rate change, the Insurance Commissioner shall, within three (3) business days, post the rate filing including all information required under Section 5 of this act on the Insurance Department’s website, along with the insurer’s rate filing summary required under Section 5 of this act.
B.  The Commissioner shall prominently post links on the Department’s website to a webpage on which rate filings and summaries can be found.  Links to rate filings and summaries shall be clearly labeled by name of the insurer, type of policy, and the filing date of the proposed rate change.  If the Commissioner uses a searchable database to publicly post rate filings, the Commissioner shall post search instructions and plain-language explanatory material sufficient to make it easy to find a rate filing in the database.
SECTION 5.     NEW LAW     A new section of law to be codified in the Oklahoma Statutes as Section 4420.5 of Title 36, unless there is created a duplication in numbering, reads as follows:
A.  Every rate filing submitted under Section 3 of this act for a proposed rate change shall include sufficient information and data to allow the Insurance Commissioner to consider the factors set forth in Section 7 of this act, any factors established under federal regulations concerning “unreasonableness” of premiums, and any other factors required by the Commissioner.
B.  The information in the rate filing shall be presented in a standard format to be determined by a rule promulgated by the Commissioner, with information clearly labeled under headings.
C.  The Commissioner shall promulgate rules to establish the specific data and information required to be included in the rate filing to allow the Commissioner to consider the factors in Section 7 of this act, any factors under federal or state law, and any other information that the Commissioner determines should be submitted.  The Commissioner may adopt and require use of the disclosure form used for justification of premium increases under Section 2794 of Title 42 of the United States Code (Patient Protection and Affordable Care Act), except that the Commissioner shall require additional disclosures in a standard format to the extent that the federal disclosure form does not include the information required to consider the factors in Section 7 of this act, the information required under this section, and any additional information that the Commissioner determines should be submitted.
D.  The rules establishing the specific data and information required in the filing shall ensure that each filing includes, but is not limited to:
1.  A Rate Filing Summary which must explain the filing in a manner that allows consumers to understand the rate change.  The summary shall be in accordance with a form established by the Commissioner.  The information contained in this summary must match the information provided elsewhere in the filing;
2.	a.	An Actuarial Memorandum which shall describe the benefit plan for each product and a description of any changes to the benefit plan.  The actuarial memorandum shall report:
(1)	an insurer’s overall medical trend factor assumed, and also broken down by rate of price inflation and rate of utilization changes,
(2)	medical trend for the two most recent twelve-month experience periods, itemized by rate of price inflation and rate of utilization changes,
(3)	medical trend for the two most recent twelve-month experience periods, disaggregated by category of type of medical reimbursement, including hospital inpatient, hospital outpatient, physician services, prescription drugs and other ancillary services, including laboratory, and radiology; medical trend for each category should also be itemized by rate of price inflation and rate of utilization changes,
(4)	medical trend for the two most recent twelve-month experience periods, broken down by major geographic region of the state.  For purposes of this section “major geographic region” shall correspond to any areas defined under any geographic rating factors used, or shall be defined by the Commissioner, and
(5)	an insurer requesting a rate change shall also provide information on aggregate cost increases for specific hospitals and for specific medical groups within a plan network,
b.	The actuarial memorandum shall explain how the proposed rate change was calculated, including a description of all assumptions, factors, calculations, and any other information pertinent to the proposed rate.  The insurer must clearly identify and quantify medical trend factors and all other factors used in developing the rates,
c.	The insurer must provide detailed support for each assumption used to determine the proposed rate change.  These assumptions must each be separately discussed, adequately supported, and also be appropriate for the specific line of business, product design, benefit configuration, and time period.  Any and all factors affecting the projection of future claims must be presented and adequately supported.  The trend assumptions shall be, if practical, separately quantified into two categories, medical and insurance:
Medical = provider price increases + utilization changes
Insurance = underwriting wear-off (duration), deductible leveraging, other factors and assumptions,
d.	The actuarial memorandum shall include rate tables, presented as determined by the Commissioner,
e.	The actuarial memorandum shall, for each plan subject to a proposed increase, show the average increase, as well as the maximum increase to be charged for any policyholder and the minimum increase to be charged for any policyholder, and
f.	The actuarial memorandum shall include the signature of and date that a qualified actuary reviewed the rate filing;
3.  A description of cost containment and quality improvement efforts in which the insurer must explain any changes the insurer has made in its health care cost containment efforts and quality improvement efforts since the insurer's last rate filing for the same category of health benefit plan, including a description of any factors that relate to the Commissioner’s consideration of affordability under Section 7 of this act;
4.  A disclosure of certain expenses in which the insurer shall include information sufficient to show expenses relating to:
a.	salaries, wages, bonuses or other compensation benefits,
b.	broker commissions,
c.	rent or occupancy expenses,
d.	marketing and advertising,
e.	federal and state lobbying expenses,
f.	all political contributions,
g.	all dues paid to trade groups that engage in lobbying or make political contributions,
h.	general office expenses, including but not limited to sundries, supplies, telephone, printing and postage,
i.	third party administration expenses or fees or other group service expense or fees,
j.	legal fees and expenses and other professional or consulting fees,
k.	other taxes, licenses and fees,
l.	travel expenses, and
m.	charitable contributions.
When possible, the insurer should show how the expenses in this section were applied on a per member per month basis to the rates subject to the proposed rate change; and
5.  A certification of compliance in which the rate application shall be signed by the officers of the insurer who exercise the functions of a chief executive and chief financial officer.  Each officer shall certify that the representations, data, and information provided to the department to support the application are true and that the filing complies with state statutes, rules, product standards and filing requirements.
SECTION 6.     NEW LAW     A new section of law to be codified in the Oklahoma Statutes as Section 4420.6 of Title 36, unless there is created a duplication in numbering, reads as follows:
A.  An insurer shall send written notice of a proposed rate change to each policyholder affected by the change on or before the date the rate filing or application is submitted to the Insurance Commissioner.  The notice shall:
1.  State in size 16-point font in bold the actual dollar amount of the proposed rate change and the specific percentage by which the current premium would be increased for the policyholder;
2.  Describe in plain, understandable terms any changes in the plan design or any changes in benefits, and highlight this information by printing in 16-point font in bold;
3.  Prominently include mailing and website addresses and telephone numbers for the insurer through which a person may request additional information;
4.  Provide information about public programs, including but not limited to Medicaid, High Risk Pools, and CHIP; and
5.  State that the proposed rate change is subject to approval by the Commissioner, and inform policyholders of the sixty-day public comment period available under this section and provide the website address of the Insurance Department where the rate filing can be found.
B.  The Commissioner shall make available an e-mail alert system in which members of the public may sign up on the Department’s website to receive notice of a proposed rate change for a selected insurer.  The Commissioner shall send such e-mail alerts within three (3) business days after receiving a rate filing proposing a rate change.
C.  Beginning on the date that the Commissioner posts on the Department website a proposed rate change pursuant to Section 4 of this act, the Commissioner shall open a sixty-day public comment period on the rate change and rate filing.  The Commissioner shall allow members of the public to comment by mail and e-mail, and the Commissioner may create a website where members of the public can publicly post comments.  The Commissioner, in his or her discretion, may convene meetings around the state for consumers to comment and ask questions.  The Commissioner shall prominently post on the Department’s website information describing the public comment period that applies to proposed rate changes and informing members of the public how to submit a comment.
D.  If a rate filing is found to be incomplete under Section 5 of this act, the Commissioner shall start a new sixty-day public comment period after the Commissioner determines that the filing is complete and posts the insurer’s complete filing on the Department website.
E.  Within thirty (30) days of the close of the sixty-day public comment period required under this section, the Commissioner shall issue a written decision with findings on the considerations listed in Section 7 of this act, and any other considerations taken into account, to approve, modify, or disapprove the proposed rates.  If, however, a hearing on the proposed rate change is held under Section 10 of this act, the Commissioner may reasonably extend the time to issue a written decision with findings to approve, modify, or disapprove the proposed rate change to accommodate a hearing schedule. Upon issuing the decision, the Commissioner shall post his or her decision on the Department’s website and provide written notice to the insurer of the decision.
SECTION 7.     NEW LAW     A new section of law to be codified in the Oklahoma Statutes as Section 4420.7 of Title 36, unless there is created a duplication in numbering, reads as follows:
A.  When making any determination pursuant to the Oklahoma Individual Market Rate Review Act, the Insurance Commissioner shall act to guard the solvency of health insurers, protect the interests of consumers of health insurance and shall encourage and direct insurers towards policies that advance the welfare of the public through overall efficiency, improved health care quality, and appropriate affordability of coverage and access.
B.  Rates shall be:
1.  Actuarially sound;
2.  Reasonable, and not excessive, inadequate, or unfairly discriminatory; and
3. Based on reasonable administrative expenses. Rates may not be deceptive or constitute an unfair trade practice.  An insurer shall have the burden to show by clear and convincing evidence that its rates comply with the terms of this subsection.
C.  The Commissioner shall disapprove a proposed rate change if the proposed rates are:
1.  Not actuarially sound;
2.  Unreasonable;
3.  Excessive;
4.  Inadequate;
5.  Unfairly discriminatory;
6.  Based on unreasonable administrative expenses;
7.  Not in the public interest; or
8.  If the rate filing is incomplete.
D.  In making the determination, the Commissioner shall consider and issue findings on the following factors:
1.  Reasonableness and soundness of actuarial assumptions, calculations, projections, and factors used by the insurer to arrive at the proposed rate change;
2.  The insurer’s historical trends for medical claims.  The Commissioner may consider, for comparison, medical trends reported by other insurers in the state, or of medical trends for the state, a region, or the country as a whole.  The Commissioner shall also consider inflation indices, such as the Consumer Price Index and the medical care component of the Consumer Price Index;
3.  Reasonableness of historical and projected administrative expenses;
4.  Compliance with medical loss ratio standards in effect under federal or state law.  The Commissioner may review and consider the insurer’s medical loss ratio disclosures submitted pursuant to the federal Patient Protection and Affordable Care Act;
5.  Whether the rate change applies to an open or closed block of business.  If it applies to a closed block of business, whether the applicant has pooled the experience of the closed block of business with all appropriate blocks of business that are not closed pursuant to Section 8 of this act;
6.  Whether the insurer has complied with all federal and state requirements for pooling risk and requirements for participation in risk adjustment programs in effect under federal and state law;
7.  The financial condition of the insurance company for at least the past five (5) years, including but not limited to profitability, surplus, reserves, investment income, reinsurance, dividends, and transfers of funds to affiliates and/or parent companies;
8.  Whether the proposed rate change and any contribution to surplus or profit margin included in the proposed rate change is reasonable in light of the entire company’s surplus level and additional factors in the previous subsection;
9.  The financial performance for at least the past five years, or total years in existence if less, of the block of business subject to the proposed rate change including but not limited to past and projected profits, surplus, reserves, investment income, and reinsurance applicable to the block;
10.  The financial performance for at least the past five years of insurer’s statewide individual market business, and the insurer’s overall statewide business;
11.  Any anticipated change in the number of enrollees if the proposed premium rate is approved;
12.  Changes to covered benefits or health benefit plan design;
13.  Whether the proposed change in the premium rate is necessary to maintain the insurer's solvency or to maintain rate stability and prevent excessive rate increases in the future;
14.  The insurer’s statement of purpose or mission in its corporate charter or mission statement;
15.  The hardship on members affected by the proposed rate change;
16.  Public comments received under Section 6 of this act pertaining to the standards set forth in this section; and
17.  Affordability of the insurance product or products subject to the proposed rate change. To assess affordability, the Commissioner shall consider:
a.	price comparison to other market rates for similar products including consideration of rate differentials, if any, between not-for-profit and for-profit insurers or between similar products offered inside of a health insurance exchange,
b.	efforts of the insurer to maintain close control over its administrative costs, and changes in the insurer's health care cost containment and quality improvement efforts since the insurer's last rate filing for the same product,
c.	implementation of strategies by the insurer to enhance the affordability of its products, including whether the insurer offers products that address the underlying cost of health care by creating appropriate incentives for consumers, employers, providers and the insurer itself that promote a focus on primary care, prevention and wellness, active management procedures for the chronically ill population; use of appropriate cost-efficient settings and use of evidence-based, quality care,
d.	whether the insurer employs provider payment strategies to enhance cost effective utilization of appropriate services,
e.	five-year rate change history for the population affected by the proposed rate change, and
f.	constraints on affordability efforts including:
(1)	state and federal requirements,
(2)	costs of medical services over which plans have limited control,
(3)	health plan solvency requirements, and
(4)	the prevailing financing system in the United States  and the resulting decrease in consumer price sensitivity.
E.  Nothing in this section shall preclude the Commissioner from considering any factor that, in the Commissioner’s discretion, is relevant to his or her determination.  The Commissioner shall have authority to promulgate rules to facilitate consideration of the factors in this section.  Nothing in this section shall preclude the Commissioner from requesting from an insurer information or data to support these factors or factors not on this list.
SECTION 8.     NEW LAW     A new section of law to be codified in the Oklahoma Statutes as Section 4420.8 of Title 36, unless there is created a duplication in numbering, reads as follows:
Until such time as subsection C of Section 1312 of the Patient Protection and Affordable Care Act is fully in effect in the state, an insurer must pool the experience of a closed block of business with all appropriate blocks of business that are not closed for the purpose of determining the premium rate of any policy within the closed block, with no rate penalty or surcharge beyond that which reflects the experience of the combined pool.  A closed block of business is a policy or group of policies that are no longer being marketed or sold by the insurer, or that has less than five hundred (500) in-force contracts in this state, or for which enrollment has dropped by more than twelve percent (12%) since the last rate filing.
SECTION 9.     NEW LAW     A new section of law to be codified in the Oklahoma Statutes as Section 4420.9 of Title 36, unless there is created a duplication in numbering, reads as follows:
A.  If the Insurance Commissioner approves a rate change, the Commissioner shall provide written notice to the insurer that rates have been approved.  Upon receipt of a notice of approval, the insurer shall send written notice by first class mail to all policyholders affected by the rate change.  The notice shall inform policyholders in size 16-point font in bold the actual dollar amount of the approved premium rate increase for the policyholder, the specific percentage by which the current premium will be increased for the policyholder, the effective date of the new rate, a description in plain, understandable terms of any changes in plan design or any changes in benefits including a reduction in benefits or changes to waivers, exclusions or conditions, and highlight this information by printing in 16-point font in bold.  The notice shall also provide information about public programs, including but not limited to Medicaid, High Risk Pools, and CHIP.
B.  No approved rate shall be effective less than sixty (60) days from a policyholder’s receipt of the notice required under this section.
SECTION 10.     NEW LAW     A new section of law to be codified in the Oklahoma Statutes as Section 4420.10 of Title 36, unless there is created a duplication in numbering, reads as follows:
A.  At any time during the sixty-day public comment period required under Section 6 of this act, the Insurance Commissioner shall issue an order scheduling a public hearing on the proposed rate change if:
1.  A consumer or his or her representative or a consumer advocacy group requests a hearing within forty-five (45) days of the opening of the public comment period.  Any person requesting a hearing under this paragraph shall submit the request in writing.  Upon receiving a request, the Commissioner shall decide within fifteen (15) days whether to grant the hearing, and if the Commissioner decides not to grant the hearing, the Commissioner shall issue written findings in support of that decision;
2.  The Commissioner on his or her own motion determines to hold a hearing;
3.  The proposed rate change is “unreasonable” under the federal Patient Protection and Affordable Care Act;
4.  The Attorney General requests a hearing;
5.  The Consumer Advocate responsible for reviewing rate filings under Section 11 of this act requests a hearing; or
6.  If the rate request exceeds ten percent (10%), or the proposed rate change would result in an annual increase exceeding ten percent (10%).
B.  The Commissioner shall promulgate rules governing hearings. Those rules shall, at a minimum, include timelines for scheduling and commencing hearings, and procedures to prevent delays in commencing or continuing hearings without good cause.
C.  Hearings shall be conducted by a hearing examiner. The hearing examiner shall render a decision within thirty (30) days of the closing of the record in the proceeding.  The Commissioner shall adopt, amend or reject a decision by the hearing examiner within ten (10) days of the hearing examiner’s decision.  Hearings shall be conducted pursuant to Administrative Procedures Act; however, notwithstanding any provision of the Administrative Procedures Act, the hearing examiner shall take judicial notice of the public comments received during the hearing or the public comment period.  This provision shall not be read to preclude any other judicial notice.
D.  For purposes of judicial review, a decision to hold a hearing is not a final order or decision; however, a decision not to hold a hearing is final.
E.  The Commissioner shall provide notice of the hearing not less than fourteen (14) days prior to the hearing.  The notice shall be prominently published on the Insurance Department’s website and in a newspaper or newspapers having aggregate general circulation throughout the state at least fourteen (14) days prior to the hearing.  The notice shall contain a description of the rates proposed to be charged and a copy of the notice shall be sent to the insurer.  In addition, the insurer shall provide by first class mail, at least fourteen (14) days prior to the public hearing, notice of the public hearing to all affected policyholders.  The notice shall:
1.  Describe the proposed rate change.  The public notice shall also provide information on opportunities for the public to provide comment on the proposal to the Commissioner; and
2.  Be published in all languages spoken by five percent (5%) or more of the policyholders, or 1,000 people in the service area, whichever is less.
F.  All documents, public comments, and correspondence with the Department submitted as part of the hearing are public records.  The Commissioner shall provide prompt and reasonable access to the records concerning the proposed rate request to the public at no charge.  The records shall be considered public records and be posted on the Department’s website.
G.  The Commissioner may contract with actuaries and/or subject matter experts to assist him or her in conducting the review or hearing required pursuant to the Oklahoma Individual Market Rate Review Act. The actuary or other expert shall serve under the direction of the Commissioner. The Commissioner is exempt from the provisions of the Oklahoma Central Purchasing Act for purposes of entering into contracts pursuant to this subsection.
SECTION 11.     NEW LAW     A new section of law to be codified in the Oklahoma Statutes as Section 4420.11 of Title 36, unless there is created a duplication in numbering, reads as follows:
There is created within the Insurance Department a position to be known as the "Consumer Advocate" who shall represent and advocate on behalf of the interests of health insurance policyholders and members.  The goal of the Consumer Advocate shall be to obtain the lowest possible rates for health insurance consistent with protection of insurer solvency.
Any rate increase request greater than ten percent (10%), or resulting in an annual increase greater than ten percent (10%), shall be reviewed by the Consumer Advocate.  The Consumer Advocate may employ legal assistants, experts and actuaries necessary to carry out its function of advocating on behalf of policyholders and members.  The Insurance Commissioner shall ensure that such personnel and assistance are provided at a level sufficient to ensure that policyholder and member interests are effectively represented in all proceedings provided for in the Oklahoma Individual Market Rate Review Act.
SECTION 12.     NEW LAW     A new section of law to be codified in the Oklahoma Statutes as Section 4420.12 of Title 36, unless there is created a duplication in numbering, reads as follows:
A.  The Insurance Commissioner, on timely application, shall allow any person with an interest in the outcome of a proposed rate change to intervene as a party to that proceeding.  Policyholders, insured members, consumer advocates, and community representatives shall all be considered persons with an interest.  Any person whose interest is determined to be affected may present evidence, examine and cross-examine witnesses, and offer oral and written arguments, and in connection therewith may conduct discovery proceedings in the same manner as is allowed in the court of this state.  The specific intervention provisions of the Oklahoma Individual Market Rate Review Act shall control in the event of a conflict with the requirements of general state administrative law.
B.  This section does not limit the power of the Commissioner to consolidate parties with similar interests for the purpose of intervention.
C.  The Commissioner or a court shall award reasonable advocacy and witness fees and expenses to any person who demonstrates that (1) the person represents the interests of consumers, and (2) that he or she has made a substantial contribution to the adoption of any order, regulation or decision by the Commissioner or a court.
D.  A final action by the Commissioner shall be subject to judicial review by the court in the county where services are rendered at the initiation of the insurer or any person that was a party to a proceeding under the Oklahoma Individual Market Rate Review Act.
SECTION 13.  This act shall become effective November 1, 2011.

53-1-1149	ARE	1/19/2011 4:24:34 PM