Geisinger Health Plan v. DHS (OOR)

CourtCommonwealth Court of Pennsylvania
DecidedDecember 15, 2022
Docket15, 19, 24 and 26 C.D. 2021
StatusUnpublished

This text of Geisinger Health Plan v. DHS (OOR) (Geisinger Health Plan v. DHS (OOR)) is published on Counsel Stack Legal Research, covering Commonwealth Court of Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Geisinger Health Plan v. DHS (OOR), (Pa. Ct. App. 2022).

Opinion

IN THE COMMONWEALTH COURT OF PENNSYLVANIA

Geisinger Health Plan, : : Petitioner : : v. : No. 15 C.D. 2021 : Argued: February 7, 2022 Department of Human Services : (Office of Open Records), : : Respondent :

UPMC For You, Inc., : : Petitioner : : v. : No. 19 C.D. 2021 : Department of Human Services : (Office of Open Records), : : Respondent :

Aetna Better Health : of Pennsylvania Inc., : : Petitioner : : v. : No. 24 C.D. 2021 : Department of Human Services : (Office of Open Records), : : Respondent : Vista Health Plan, Inc., AmeriHealth : Caritas Health Plan and Keystone : Family Health Plan, : : Petitioners : : v. : No. 26 C.D. 2021 : Department of Human Services : (Office of Open Records), : : Respondent :

BEFORE: HONORABLE MICHAEL H. WOJCIK, Judge HONORABLE CHRISTINE FIZZANO CANNON, Judge HONORABLE LORI A. DUMAS, Judge

OPINION NOT REPORTED

MEMORANDUM OPINION BY JUDGE WOJCIK FILED: December 15, 2022

In these consolidated appeals, Aetna Better Health of Pennsylvania (Aetna), Geisinger Health Plan (Geisinger), UPMC For You, Inc. (UPMC), and Vista Health Plan, Inc., AmeriHealth Caritas Health Plan, and Keystone Family Health Plan (collectively, AmeriHealth Caritas) petition for review of the Final Determination Upon Reconsideration of the Office of Open Records (OOR) granting in part, denying in part, and dismissing as moot in part, Aetna’s request for records from the Pennsylvania Department of Human Services (DHS) under the provisions of the Right-to-Know Law (RTKL).1 After careful review, we affirm in part and vacate in part.

1 Act of February 14, 2008, P.L. 6, 65 P.S. §§67.101-67.3104. 2 I. In order to understand the claims raised in the instant appeal, a brief recounting of a number of related cases is necessary. This Court has recently noted:

[The HealthChoices Medicaid (HealthChoices) Program] is a managed care program for Medicaid recipients. Managed care organizations (MCOs) administer the HealthChoices Program in five Pennsylvania zones - Northeast, Southeast, Lehigh- Capital, Northwest, and Southwest. [DHS] contracts with multiple MCOs to administer HealthChoices Program benefits and services in each zone. Aetna is one of those MCOs. It has provided administration by contract with [DHS] in two zones since 2010 and in all five zones since 2012.

***

In September 2015, [DHS] issued Request for Proposals (RFP) 06-15 for new contracts for administration of the HealthChoices Program in all five zones. Aetna, which was already administering the program as an MCO, submitted proposals for all five zones. However, [DHS] did not select Aetna to negotiate for new contracts.

Aetna claim[ed] that in evaluating applications under RFP 06-15, [DHS] stated it applied what it called a “heritage factor” in evaluating the proposals by all applicants. See Aetna Better Health of P[ennsylvania], Inc. v. Dep[artmen]t of Hum[an] Serv[ices] (Pa. Cmwlth., No. 351 M.D. 2016, filed July 19, 2016), slip op. at 4-5[.] [DHS] applied the heritage factor to favor any existing applicant having at least a 25% market share of Medicaid participants, reasoning that the disruption likely to arise from cessation of such an applicant’s services would outweigh some shortfall in the rest of the applicant’s evaluation scores. Id. However, [DHS] did not disclose in the RFP that it would be applying the heritage factor as part of its evaluation process.

3 Aetna describe[d] the heritage factor as a “secret criterion” used to deprive Aetna of new contracts and to favor other MCOs despite Aetna’s higher proposal scores. Aetna therefore filed a bid protest. [DHS] responded by asserting that Aetna could not protest based on that issue. Aetna then filed a petition for review. This Court enjoined the RFP 06-15 procurement and ordered that if [DHS] chose to review Aetna’s bid protest, that review should be by an independent hearing officer not employed by [DHS] and not connected to the RFP. See Aetna Better Health, slip op. at 32.

[DHS] then withdrew RFP 06-15 and reissued it as “RFP 06-15 (Reissued).” Aetna again submitted a proposal, and [DHS] again did not select Aetna for negotiations regarding a contract in any zone. Whether [DHS] again applied the heritage factor is unclear. However, Aetna claim[ed] [DHS] “secretly structured the evaluation criteria and formulas in a manner designed to achieve a predetermined result, to favor the very same MCOs that received contracts with the original RFP only through application of the [h]eritage [f]actor.” Aetna also allege[d] [DHS] “had secret discussions” with another MCO about modifying its bid proposal in order to pass [DHS’s] readiness review procedure.

Aetna and other applicants filed bid protests to RFP 06-15 (Reissued), which [DHS] denied. This Court reversed [DHS], concluding that discussions with MCOs about bid modifications and readiness review violated the RFP and the Commonwealth Procurement Code (Procurement Code)[2] because only [DHS’s] designated Issuing Officer, Karen Kern (Kern), may engage in such discussions. UnitedHealthcare of P[ennsylvania], Inc. v. Dep[artmen]t of Hum[an] Serv[ices] (Pa. Cmwlth., No. 790 C.D. 2017, filed Apr[il] 10, 2018), slip op. at 27[.]

In October 2019, [DHS] issued [the Request for Applications (RFA)] in a third attempt to seek new

2 62 Pa. C.S. §§101-2311. 4 contracts regarding administration of the HealthChoices Program. Aetna submitted an application for all five zones. [DHS] did not select Aetna for negotiations in any zone. Aetna received the lowest score of all applicants, although its scores had been among the highest for RFP 06-15.

Aetna requested debriefing as permitted by . . . the RFA. [DHS] provided debriefing documents consisting of a redacted Selection Memorandum and another document setting forth some, but not all, of [DHS’s] determinations concerning the strengths and weaknesses of Aetna’s application. [DHS] refused to provide any other applicants’ raw scores, comparative analysis of the applicants, or information about other MCOs’ applications. Allegedly departing from past practice, [DHS] also declined to provide an interactive debriefing conference. [DHS] did allow Aetna to submit written questions but had not answered them as of the date of filing of the petition for review. Aetna assert[ed] that it needed answers to its questions in order to determine whether it had grounds for additional bid protests.

Aetna filed several bid protests regarding the RFA and later consolidated them. . . . Aetna requested an evidentiary hearing on its bid protests, but the [Secretary of Human Services (Secretary)] denied Aetna’s request.

On December 4, 2020, the Secretary issued the Final Determination denying Aetna’s bid protests. The Secretary concluded [DHS’s] evaluation and selection were not clearly erroneous, arbitrary, capricious, contrary to law, or an abuse of discretion. Aetna Better Health of Pennsylvania, Inc. v. Pennsylvania Department of Human Services (Pa. Cmwlth., No. 652 M.D. 2020, filed November 17, 2021), slip op. at 2- 6 (citations to record omitted). Ultimately, this Court affirmed the Secretary’s Final Determination denying Aetna’s bid protests under the RFA and the Procurement

5 Code, and denied Aetna’s request for declaratory judgment and mandamus relief regarding any debriefing issues. See id. at 11-27.

II. With respect to the instant appeal, on July 15, 2020, Aetna filed a request for the following records from DHS:

1. [C]opies of all public records associated with [DHS’s] response to all bidders’ proposals submitted in response to [the RFA].

2. [A]ny documents related to the decision referenced in DHS’s July 1, 2020 letter . . .

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Related

Unitedhealthcare of Pa., Inc. v. Pa. Dep't of Human Servs.
187 A.3d 1046 (Commonwealth Court of Pennsylvania, 2018)
Bowling v. Office of Open Records
75 A.3d 453 (Supreme Court of Pennsylvania, 2013)

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Bluebook (online)
Geisinger Health Plan v. DHS (OOR), Counsel Stack Legal Research, https://law.counselstack.com/opinion/geisinger-health-plan-v-dhs-oor-pacommwct-2022.