Commonwealth, Department of Public Welfare v. Eiseman

125 A.3d 19, 633 Pa. 366, 2015 WL 6472626
CourtSupreme Court of Pennsylvania
DecidedOctober 27, 2015
Docket45 EAP 2014, 46 EAP 2014, 47 EAP 2014
StatusPublished
Cited by38 cases

This text of 125 A.3d 19 (Commonwealth, Department of Public Welfare v. Eiseman) is published on Counsel Stack Legal Research, covering Supreme Court of Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Commonwealth, Department of Public Welfare v. Eiseman, 125 A.3d 19, 633 Pa. 366, 2015 WL 6472626 (Pa. 2015).

Opinions

OPINION

Chief Justice SAYLOR.

These appeals, as well as a companion set, concern the extent of the public’s statutory right of access to discrete information about the implementation of the Medical Assistance Program.

[369]*369In Pennsylvania, the Medical Assistance or Medicaid Program is administered by the Commonwealth’s Department of Human Services, which, in the time period relevant to the events underlying these appeals, was known as the Department of Public Welfare (“DPW” or the “Department”). Funded jointly by the federal and state governments, Medicaid directs public monies toward the provision of healthcare services to qualifying individuals with low incomes and limited resources. See generally 42 U.S.C. §§ 1396-1396w-5; 62 P.S. §§ 441.1-449. In implementing one pillar of the delivery system in the Commonwealth—via a program called Health-Choices—DPW has negotiated and contracted with various managed care organizations (“MCOs”) to render the essential services available to enrollees. In the program’s Southeast Zone,1 five MCOs were selected.2

As is pertinent here, HealthChoices encompasses the provision of dental care to low-income children, certain adults, and some persons with disabilities in Pennsylvania. The five MCOs serving enrollees in the Southeast Zone engaged DPW-approved dental subcontractors (“Subcontractors”) to fulfill the larger measure of the MCOs’ contractual obligations. See generally Dental Benefit Providers, Inc. v. Eiseman, 86 A.3d 932, 937 (Pa.Cmwlth.2014) (indicating that “[sjubcontractors have built sophisticated networks of providers, enabling them to provide services to enrollees in a cost-effective manner.”). Subcontractors then contracted with and paid providers of dental health care services to examine and treat Medicaid enrollees. In a few instances, however, MCOs arranged for services directly with providers.

In June 2011, James Eiseman, Jr. and the Public Interest Law Center of Philadelphia (“Requesters”) tendered requests to DPW seeking records revealing, among other things, the [370]*370rates that DPW paid to the MCOs for dental services in the Southeast Zone (the “Capitation Rates”), and the amounts paid by MCOs to provide dental services (the “MCO Rates”). These were submitted per the Right-to-Know Law.3

DPW denied the requests in relevant part. As is most germane to our present consideration, with regard to the MCO Rates, the Department indicated that it had been informed by each of the MCOs that the rates were “trade secrets and/or confidential proprietary information” protected against disclosure. See 65 P.S. § 67.708(b)(ll) (generally exempting from the requirement of public access a “record that constitutes or reveals a trade secret or confidential proprietary information”). Significantly, the Department did not deny that it possessed pertinent records; rather, it related that the MCOs had instructed that “DPW is not to disclose” the rates. Letter of DPW Open Records Officer to James Eiseman, Jr., dated July 25, 2011, at 6.

Requesters lodged an appeal in the Office of Open Records (the “OOR”). See 65 P.S. § 67.1101. See generally Bowling v. OOR, 621 Pa. 133, 141-42, 75 A.3d 453, 457-58 (2013) (describing the administrative tier of the appeals process under the RTKL). The five MCOs intervened as direct-interest participants, see 65 P.S. § 67.1101(c), relying upon the trade-secrets/confidential-proprietary-information exemptions.4

At an evidentiary hearing, the MCOs offered expert and lay testimony to support the claimed exemptions. Additionally, the organizations adduced evidence that the disclosure of rate information would lessen the value of their investment in negotiating favorable rates.

The OOR, however, issued a final determination granting the relevant records requests. Initially, the appeals officer observed that records in the possession of a Commonwealth agency are presumed to be public, unless they qualify for an [371]*371exemption under the RTKL or other law or are protected by a privilege, judicial order, or decree. See id. § 67.305; accord Bowling, 621 Pa. at 140, 75 A.3d at 457. Furthermore, he explained, the Law places the burden of proof upon a public body to demonstrate exemptions. See 65 P.S. § 67.708(a).

Of particular significance to his legal analysis, the appeals officer noted that the trade-secrets/confidential-proprietary-information exception does not extend to one statutorily-defined subset of public records, namely “financial records.” Id. § 67.708(c) (prescribing that “[t]he exceptions set forth in subsection (b) shall not apply to financial records,” subject to certain enumerated exceptions not applicable here). “Financial records,” the appeals officer elaborated, include “[a]ny account, voucher, or contract dealing with ... the receipt or disbursement of funds by an agency; or ... an agency’s acquisition, use or disposal of services[.]” Id. § 67.102. Since the Department’s agreements with the MCOs (containing the Capitation Rates) dealt with “the disbursement of billions of dollars in taxpayer funds for the acquisition of health insurance for Medicaid participants,” the appeals officer concluded that they “cannot be considered anything but a ‘financial record’ under the RTKL.” Final Determination in Eiseman v. DPW, No. AP 2011-1098, slip op. at 15 (OOR Sept. 17, 2012).

In the alternative, the appeals officer also considered whether the rates of payment to MCOs could be considered trade secrets or confidential proprietary information. He explained that a “trade secret” is defined by the RTKL, as well as in Pennsylvania’s Uniform Trade Secrets Act,5 as:

Information, including a formula, drawing, pattern, compilation including a customer list, program, device, method, technique or process that: ... [djerives independent economic value, actual or potential, from not being generally known to, and not being readily ascertainable by proper means by, other persons who can obtain economic value from its disclosure or use; and ... [i]s the subject of efforts [372]*372that are reasonable under the circumstances to maintain its secrecy.

12 Pa.C.S. § 5302; see 65 P.S. § 67.102 (reflecting a materially identical formulation). See generally Final Determination in Eiseman, No. AP 2011-1098, slip op. at 13 (“[The Uniform Trade Secrets Act] provides injunctive relief and monetary damages to parties who have been harmed by the misappropriation of trade secrets, while the RTKL provides parties with protection from public disclosure by government agencies of records which contain trade secrets.” (citations omitted)). The appeals officer also related that the term “confidential proprietary information” is defined by the RTKL as “[c]om-mercial or financial information received by an agency: ... which is privileged or confidential; and ... the disclosure of which would cause substantial harm to the competitive position of the person who submitted the information.” 65 P.S. § 67.102.

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Cite This Page — Counsel Stack

Bluebook (online)
125 A.3d 19, 633 Pa. 366, 2015 WL 6472626, Counsel Stack Legal Research, https://law.counselstack.com/opinion/commonwealth-department-of-public-welfare-v-eiseman-pa-2015.