Good Shepherd Medical Center, Inc. v. State

Procedural entryThis page is a short order in Good Shepherd Medical Center, Inc. v. State. Read the opinion of the Court — 2010 Tex. App. LEXIS 1184
Court of Appeals of Texas·Decided February 18, 2010·No. 03-06-00448-CV·Published

Opinion

TEXAS COURT OF APPEALS, THIRD DISTRICT, AT AUSTIN

NO. 03-06-00448-CV

Good Shepherd Medical Center, Inc., Appellant

v.

The State of Texas; Teacher Retirement System of Texas; and Ronnie G. Jung, in his capacity as Executive Director of the Teacher Retirement System of Texas, Appellees

FROM THE DISTRICT COURT OF TRAVIS COUNTY, 250TH JUDICIAL DISTRICT NO. D-1-GN-03-003352, HONORABLE LORA J. LIVINGSTON, JUDGE PRESIDING

OPINION

Good Shepherd Medical Center, Inc. (Good Shepherd) appeals a district court

judgment dismissing, for lack of standing, its declaratory claims challenging the constitutionality of

two statutes. The judgment also addressed the merits—it held that Good Shepherd take nothing on

its claims and granted two intervenors affirmative declarations that the statutes were constitutional.

In three issues, Good Shepherd contends that the district court erred in holding that it lacked

standing, in proceeding to reach the merits after holding that Good Shepherd lacked standing, and

in rejecting Good Shepherd’s constitutional challenges and declaring the statutes to be constitutional.

We will affirm the district court’s judgment that Good Shepherd failed to demonstrate its standing.

However, because we conclude this ruling deprived the district court of subject-matter jurisdiction

to reach the merits of either Good Shepherd’s or the intervenors’ claims, we must modify the district court’s judgment to delete the portions adjudicating those issues and instead dismiss the

claims for want of subject-matter jurisdiction.

BACKGROUND

At relevant times, the statutory charges of appellee Teacher Retirement System of

Texas (TRS) have included the provision of statewide health care benefit programs for both active

and retired employees of Texas school districts. The benefit program for school-district retirees

is known as “TRS-Care,” while the program for active employees is known as “TRS-ActiveCare.”

At relevant times, both programs have delivered services through what is known as a “preferred

provider organization” or “PPO” model, in which plan members are required or incentivized to use

a “network” of health care providers that have contracted to provide services to plan members under

reduced rates or other favorable terms. In exchange for agreeing to such terms, these “in-network”

health care providers obtain a competitive advantage over any “out-of-network” rivals in that plan

members are “steered” to “in-network” providers by the plan’s restrictions or incentives.

Beginning in 1993, TRS had contracted directly with health care providers to serve

as the network for TRS-Care members. With TRS-ActiveCare, however, TRS contracted with

Blue Cross Blue Shield of Texas (BCBSTX) to serve as the statewide third-party administrator.

BCBSTX, in turn, utilized a preexisting PPO network of physicians and hospitals to serve as its

network for TRS-ActiveCare members.

Effective September 1, 2003, the 78th Texas Legislature imposed the following

limitations on TRS’s powers to contract with health care providers or third-party administrators to

provide health care benefits to TRS-Care members:

2 The Teacher Retirement System of Texas, as trustee, may not contract for or provide a health benefit plan that excludes from participation in the network a general hospital that:

(1) is located within the geographical service area or areas of the health coverage plan that includes a county that:

(A) has a population of at least 100,000 and not more than 175,000; and

(B) is located in the Texas-Louisiana border region, as that term is defined in Section 2056.002(e), Government Code; and,

(2) agrees to provide medical and health care services under the plan subject to the same terms and conditions as other hospital providers under the plan.

Act of June 2, 2003, 78th Leg., R.S., ch. 201, § 50, sec. 1575.163, 2003 Tex. Gen. Laws 812, 827,

codified at Tex. Ins. Code Ann. § 1575.163 (West 2009). In the same bill, the legislature enacted

a virtually identical limitation on TRS’s powers to contract with regard to the TRS-ActiveCare

program. See Act of June 2, 2003, 78th Leg., R.S., ch. 201, § 56, art. 3.50-7A, 2003 Tex. Gen. Laws

812, 828, previously codified at Texas Ins. Code Ann. art. 3.50-7A, repealed by Act of May 17,

2007, 80th Leg., R.S., ch. 730, § 1G.003, sec. 1579.108, 2007 Tex. Gen. Laws, 1356, 1375-76,

codified at Tex. Ins. Code Ann. § 1579.108 (West 2009) (referring to “health coverage plan” rather

than “health benefit plan” and omitting “and conditions”) (collectively, the “2003 amendments”).

Simply described, the 2003 amendments meant that TRS was required to provide (or contract to

provide) a health care plan serving TRS-Care or TRS-ActiveCare members that made “in-network”

status available to any “general hospital” in the defined geographic area that agreed to the “same

terms and conditions as other hospital providers under the plan.” This type of arrangement, termed

an “any willing provider” regime, stands in contrast to one in which the plan administrator is free

3 to contract selectively with health care providers and/or consider criteria other than the provider’s

agreement to agree to predetermined terms, conditions, or rates in deciding whether to allow a

provider into the network.

Appellant Good Shepherd owns and operates a hospital in Longview, Gregg County,

Texas. Appellee Longview Medical Center, L.P. d/b/a Longview Regional Medical Center

(Longview Regional) owns a smaller hospital in Longview and is Good Shepherd’s chief competitor.

Appellee East Texas Medical Center (ETMC) owns and operates a hospital in Tyler, Smith County,

Texas. There is no dispute that at relevant times, each of these hospitals was a “general hospital”

within the meaning of the 2003 amendments and that each hospital’s location was within the

amendments’ geographic and population brackets. There is also no dispute that Gregg and Smith

counties were the only counties in the state at the time that fell within the 2003 amendments’

geographic and population brackets.

Prior to the enactment of the 2003 amendments, it is undisputed that both

Good Shepherd and Longview Regional were in TRS’s network of providers that served TRS-Care

members. However, beginning in 1995 and until the 2003 amendments, Good Shepherd had been

the sole general hospital in Longview with in-network status under the BCBSTX PPO that served

TRS-ActiveCare members. A BCBSTX representative, Darren Rodgers, testified that BCBSTX

had chosen to allow Good Shepherd and not Longview Regional into its network based on

considerations of customer preferences, access needs in the area, and pricing. There was also

evidence that Good Shepherd had a history of using its leverage as the largest general hospital in

Longview to dissuade other health plans from allowing Longview Regional into their networks,

4 including threatening to withdraw from the networks unless the plans agreed to increase the

hospital’s reimbursement rates.

After the 2003 amendments were enacted, BCBSTX, in an attempt to comply

with the new requirements, allowed Longview Regional into its network alongside Good Shepherd.

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