No. 30276 – Wednesday, March 2, 2011 at 3 p.m.

ALOHACARE, Petitioner-Plaintiff-Appellant, vs. GORDON ITO, Insurance Commissioner, Dept. Of Commerce & Consumer Affairs, Respondent-Defendant-Appellee, and UNITED HEALTHCARE INSURANCE COMPANY, dba EVERCARE, Respondent-Intervenor-Appellee, and WELLCARE HEALTH INSURANCE OF ARIZONA, INC., dba OHANA HEALTH PLAN, Respondent-Intervenor-Appellee, and DEPT. OF HUMAN SERVICES, STATE OF HAWAII, Respondent-Intervenor-Appellee. (Agency Appeal)

Attorney(s) for Petitioner/Plaintiff-Appellant:
Edward C. Kemper

Attorney(s) for Respondents/Defendants-Appellees:
James F. Nagle, Deborah Day Emerson, Deputies Attorney General (for Gordon Ito, Ins. Commissioner)

Heidi M. Rian, John F. Molay, Deputies Attorney General (for Dept. Of Human Services, State of Hawaii)

Dianne W. Brookins, Allison K. Griffiths of Alston Hunt Floyd & Ing (for Unitedhealthcare Ins. Co.)

Lorraine H. Akiba, R. John Seibert of McCorriston Miller Mukai MacKinnon (for Wellcare Health Ins. Of Arizona)

NOTE: Order assigning Circuit Court Judge Randal K.O. Lee due to a vacancy, filed 9/20/10.

NOTE: Order accepting Application for Transfer, filed 10/12/10.

NOTE: Certificate of Recusal, by Justice Paula A. Nakayama, filed 2/14/11.

NOTE: Order assigning Circuit Court Judge Rhonda A. Nishimura, in place of Justice Paula A. Nakayama, recused, filed 2/15/11.

COURT: MER, CJ; SRA, JED, JJ; Circuit Court Judge Randal K.O. Lee, due to a vacancy; Circuit Court Judge Rhonda A. Nishimura in place of Justice Nakayama, recused.

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Brief description:

Petitioner/Appellant-Appellant AlohaCare appeals from the Circuit Court of the First Circuit’s judgment in favor of Respondent/Appellee-Appellee Gordon I. Ito, Insurance Commissioner, State of Hawaii Department of Commerce and Consumer Affairs, and Respondents/Intervenors-Appellees-Appellees United HealthCare Insurance Company, dba Evercare (United); WellCare Health Insurance of Arizona, Inc., dba Ohana Health Plan (Ohana); and the Department of Human Services (DHS) entered pursuant to its December 28, 2009 Decision and Order Affirming the Insurance Commissioner’s Decision, Findings of Fact, Conclusions of Law, and Order Filed June 2, 2009. Upon application by AlohaCare, the case was transferred to this court pursuant to Hawaii Revised Statutes (HRS) § 602-58(b)(1) (Supp. 2009).

On appeal, AlohaCare argues that 1) an HMO license is required under HRS Chapter 432D to carry out the activities called for under the Quest Expanded Access (QExA) Managed Care Plans to Cover Eligible Individuals Who Are Aged, Blind, and Disabled; 2) United and Ohana’s licenses issued pursuant to HRS chapter 431:10A do not allow them to perform the services required under the QExA contracts executed with DHS; and 3) the Insurance Commissioner’s Decision effectively repeals the HMO Act.