Dental Benefit Providers, Inc. v. Eiseman

124 A.3d 1214, 633 Pa. 205, 2015 WL 6472573
CourtSupreme Court of Pennsylvania
DecidedOctober 27, 2015
Docket48 EAP 2014, 49 EAP 2014, 50 EAP 2014
StatusPublished
Cited by17 cases

This text of 124 A.3d 1214 (Dental Benefit Providers, Inc. 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
Dental Benefit Providers, Inc. v. Eiseman, 124 A.3d 1214, 633 Pa. 205, 2015 WL 6472573 (Pa. 2015).

Opinions

OPINION

Chief Justice SAYLOR.

This is the second of companion sets of appeals in which we are asked to evaluate the breadth of the public’s statutory right of access to discrete information about the implementation of the Medical Assistance Program.

The general background for these appeals is set forth in this Court’s opinion in the related case, DPW v. Eiseman, 633 Pa. 366, 125 A.3d 19, 2015 WL 6472626 (2015), and that context, as well as the conventions utilized there, are incorporated here by reference. The present appeals primarily concern rates of payments made by Subcontractors to providers of dental health services to Medicaid enrollees in the HealthChoices Southeastern Zone from July 1, 2008, through July 30, 2012 (the “Provider Rates”).

The pertinent RTKL request lodged by the Public Interest Law Center of Philadelphia (“Requester”) sought documents, including contracts, rate schedules, and correspondence in DPW’s possession, custody, or control evidencing the Provider [208]*208Rates. Requester recognized, at least tacitly, that the Law is directed primarily to the disclosure of records “of a Commonwealth agency,” 65 P.S. § 67.102 (setting for the definition for a “public record”), and that the statutory presumption that records are public ones is directed to records “in the possession of a Commonwealth agency,” id. § 67.305(a). Requester thus contended that, even if the Department did not physically maintain custody of the requested records (since the relevant agreements were downstream contracts between Subcontractors and dental-health-services providers), DPW should be deemed to maintain constructive possession of them.

In support of this proposition, Requester highlighted a requirement contained within the standard written contract between the Department and managed care organizations designed to ensure DPW’s expedient access to information about services ultimately provided using Medicaid funds. Specifically, this ready-access provision is framed as follows:

all contracts or Subcontracts that cover the provision of medical services to the [MCOs] Members must include ... [a] requirement that ensures that the Department has ready access to any and all documents and records of transactions pertaining to the provision of services to Recipients.

HealthChoices Physical Health Agreement at 163 (version effective July 1, 2010).

Alternatively—and to the degree that responsive information was not in DPW’s possession, but rather, was contained in records of non-public entities—Requester invoked a provision of the Law which recasts certain third-party records bearing a requisite connection with the government as public records “of [a Commonwealth] agency.” 65 P.S. § 67.506(d)(1). See generally SWB Yankees LLC v. Wintermantel, 615 Pa. 640, 665, 45 A.3d 1029, 1044 (2012). In this regard, the statute prescribes that:

[a] public record that is not in the possession of an agency but is in the possession of a party with whom the agency has contracted to perform a governmental function on behalf of the agency, and which directly relates to the govern[209]*209mental function and is not exempt under this act, shall be considered a public record of the agency for purposes of this act.

65 P.S. § 67.506(d)(1).

First, Requester noted that “implementing the Medicaid program is a governmental function,” while positing that payments to providers—and, hence, the Provider Rates—were an integral aspect of such administration. Letter Brief for Requester, Eiseman v. DPW, Dkt. No. AP 2012-2017 (Pa. OOR), at 11. Next, Requester set out to address Section 506(d)(l)’s directed focus upon records “in the possession of a party with whom the agency has contracted.” 65 P.S. § 67.506(d)(1) (emphasis added). Given that the Department simply had not contracted with Subcontractors or dental-health-services professionals within Subcontractors’ provider networks, Requester advanced the following policy-oriented rationale:

[I]f MCOs could shield their expenditures of public funds from public scrutiny under the Right>-to-Know Law simply by delegating some or all of their functions to subcontractors, it would be trivial for any entity contracting with a public agency to do so. Surely, the Right-to-Know Law and the meaning of “agency possession” therein may not be read so narrowly and must be read to encompass any subcontractor as well as contractor to a government agency.

Letter Brief for Requester, Eiseman v. DPW, Dkt. No. AP-2012-2017, at 11-12.

DPW denied the request, citing, inter alia, the RTKL exception permitting the withholding of a “record that constitutes or reveals a trade secret or confidential proprietary information,” 65 P.S. § 67.708(b)(ll), along with the Pennsylvania Uniform Trade Secrets Act.1

Requesters lodged an appeal in the OOR, and the MCOs and Subcontractors obtained leave to appear as direct-interest participants and submitted position statements accompanied [210]*210by supportive materials.2 DBP, et al, succinctly summarized the relevant argument as follows:

Under [Section 506(d)(1) ], agency “possession” is satisfied respecting materials that are actually held by third parties only where: (1) the materials are in the hands of a third party with whom the agency has contracted, and (2) the materials pertain to a governmental function that the third party has contracted to carry out.,.. DPW[, however,] has contracted with the MCOs to carry out the HealthChoices program, not the dental subcontractors. DPW has no direct contractual relationship with the dental subcontractors. Accordingly, the first essential element is missing such that agency “possession” is not satisfied here. As such, the OOR cannot compel disclosure of any materials in the hands of the dental subcontractors.

Letter of DBP, et al., dated Jan. 14, 2013, in Eiseman v. DPW, Dkt. No. AP 2012-2017, at 8 (emphasis in original); accord Letter of Aetna, et al, dated January 14, 2013, in Eiseman, No, AP 2012-2017, at 9-10.

Based on these submissions, the OOR subsequently issued a final determination granting the request for records in full. Initially, the appeals officer highlighted the public policy underlying the RTKL. Eiseman v. DPW, Dkt. No. AP 2012-2017, 2013 WL 1950593, at *2 (Pa. OOR May 7, 2013) (explaining that the Law is “designed to promote access to official government information in order to prohibit secrets, scrutinize the actions of public officials and make public officials accountable for their actions.” (quoting Bowling v. OOR, 990 A.2d 813, 824 (Pa.Cmwlth.2010), aff'd, 621 Pa. 133, 75 A.3d 453 (2013))). Furthermore, he explained, the RTKL places the burden of proof upon a public body to demonstrate exemptions pertaining to public records. See 65 P.S. § 67.708(a).

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Cite This Page — Counsel Stack

Bluebook (online)
124 A.3d 1214, 633 Pa. 205, 2015 WL 6472573, Counsel Stack Legal Research, https://law.counselstack.com/opinion/dental-benefit-providers-inc-v-eiseman-pa-2015.