Health Alliance Medical Plans v. Dhfs

957 N.E.2d 447, 354 Ill. Dec. 131
CourtAppellate Court of Illinois
DecidedSeptember 12, 2011
Docket4-11-0495, 4-11-0545
StatusPublished

This text of 957 N.E.2d 447 (Health Alliance Medical Plans v. Dhfs) is published on Counsel Stack Legal Research, covering Appellate Court of Illinois primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Health Alliance Medical Plans v. Dhfs, 957 N.E.2d 447, 354 Ill. Dec. 131 (Ill. Ct. App. 2011).

Opinion

957 N.E.2d 447 (2011)
354 Ill. Dec. 131

HEALTH ALLIANCE MEDICAL PLANS, INC., an Illinois Domestic Stock Insurance Corporation, Plaintiff-Appellee,
v.
The DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES; Julie Hamos, in Her Official Capacity as Director of The Department of Healthcare and Family Services; The Executive Ethics Commission; Matt Brown, in His Official Capacity as Chief Procurement Officer of the Illinois Executive Ethics Commission; The Department of Central Management Services; and James P. Sledge, in His Official Capacity as Director of Central Management Services, Defendants-Appellants, and
Health Care Service Corporation, as Parent Company of BlueCross BlueShield of Illinois; BlueCross BlueShield of Illinois Blue Advantage; BlueCross BlueShield of Illinois HMO Illinois; PersonalCare Insurance of Illinois, Inc.; and HealthLink HMO, Inc., Defendants, and
Humana Health Plan, Inc.; and Humana Insurance Company, Defendants-Appellees.
Health Alliance Medical Plans, Inc., Plaintiff-Appellee,
v.
PersonalCare Insurance of Illinois, Inc.; The Department of Healthcare and Family Services; Julie Hamos, in Her Official Capacity as Director of the Department of Healthcare and Family Services; The Executive Ethics Commission; Matt Brown, in His Official Capacity as Chief Procurement Officer of the Illinois Executive Ethics Commission; The Department of Central Management Services; James P. Sledge, in His Official Capacity as Director of Central Management Services; and HealthLink HMO, Inc., Defendants-Appellants, and
Health Care Service Corporation, as Parent Company of BlueCross BlueShield of Illinois; BlueCross BlueShield of Illinois Blue Advantage; and BlueCross BlueShield of Illinois HMO Illinois, Defendants.

Nos. 4-11-0495, 4-11-0545.

Appellate Court of Illinois, Fourth District.

August 3, 2011.
As Modified Upon Denial of Rehearing September 12, 2011.

*448 Lisa Madigan, Attorney General, State of Illinois, Michael A. Scodro, Solicitor General, Paul Racette, Assistant Attorney General, for State of Illinois.

R. Mark Mifflin, David A. Herman, Christopher E. Sherer, Melissa G. Steward, Giffin, Winning, Cohen & Bodewes, *449 P.C., Springfield, for Health Alliance Medical Plans, Inc.

Helen E. Witt, Kirkland & Ellis, LLP, Chicago, for Health Care Service Corp.

David J. Novotny, Craig M. Bargher, Chittenden, Murday & Novotny LLC, Chicago, for Humana Health Plan, Inc. in No. 4-11-0495.

Scott T. Schutte, Gregory T. Fouts, Tedd M. Warden, Morgan, Lewis & Bockius LLP, Chicago, for PersonalCare Insurance of Illinois, Inc.

Neal F. Perryman, David W. Gearhart, Lewis, Rice & Fingersh, L.C., St. Louis, for HealthLink HMO, Inc.

William A. Chittenden III, David J. Novotny, Craig M. Bargher, Chittenden, Murday & Novotny LLC, Chicago, Steve W. Kinion, Zack Stamp, Ltd., Springfield, for Humana Health Plan, Inc. in No. 4-11-0545.

OPINION

Justice STEIGMANN delivered the judgment of the court, with opinion.

¶ 1 On June 6, 2011, Health Alliance ;Medical Plans, Inc. (Health Alliance), filed a complaint (1) challenging the decision by the director of the Department of Healthcare and Family Services (DHFS) not to renew its contract to provide open-access-plan (OAP) health insurance to state employees and (2) requesting a stay pending the outcome of its challenge. On June 10, 2011, the circuit court entered an order staying the awards of the OAP contracts "pending the ultimate determination" of this action for administrative review.

¶ 2 DHFS (No. 4-11-0495) and PersonalCare Insurance of Illinois, Inc. (PersonalCare) (No. 4-11-0545) (collectively appellants), appeal, arguing that the circuit court erred by granting Health Alliance's motion for stay pending administrative review. We disagree and affirm.

¶ 3 I. BACKGROUND

¶ 4 A. State Employees Group Insurance Act of 1971

¶ 5 The State Employees Group Insurance Act of 1971 (Insurance Act) (5 ILCS 375/1 through 17 (West 2010)) provides that it is the State's policy to assure "quality benefits" for state employees. See 5 ILCS 375/5 (West 2010). To effectuate that policy, the Insurance Act requires the director of the Department of Central Management (CMS) to contract for—or otherwise make available—health benefits for those employees. 5 ILCS 375/5 (West 2010). (In April 2005, however, the Governor signed an executive order, transferring the responsibilities related to state health-care purchasing under the Insurance Act from the director of CMS to the director of DHFS.) The Insurance Act further provides that with respect to self-insurance, the director must seek the "advice and consent" of the Commission on Government Forecasting and Accountability (COGFA). 5 ILCS 375/6.2 (West 2010). COGFA is a legislative support services agency, the membership of which consists of a bipartisan group of 12 members of the General Assembly appointed by the leadership of the General Assembly as provided by statute (25 ILCS 130/1-5(3) (West 2008) (as amended by Public Act 96-959, eff. July 1, 2010))). Among its many duties, COGFA is charged with studying and providing the General Assembly with information on economic development and fiscal trends in Illinois and on the operations of state government, recommending state fiscal and economic policies to improve the functioning of State government, and developing a three-year budget forecast for the State, including opportunities and threats concerning anticipated revenues *450 and expenditures (25 ILCS 155/3(1) through (3), (12), (14) (West 2010) (as amended by Public Act 96-958, (eff. July 1, 2010))). COGFA is also charged with overseeing the administration of the State Employees' Group Insurance Program. See 5 ILCS 375/4, 5 (West 2010).

¶ 6 B. The Types of Health Insurance the State Provides

¶ 7 The State provides health insurance benefits in two ways: (1) through managed-care plans, which include (a) health maintenance organizations (HMOs) and (b) OAPs, and (2) through preferred provider organizations (PPOs). The State self-insures the OAPs and the PPOs, which means that the State contracts with the OAPs and PPOs to administer the plans but otherwise (1) assumes all the risks and (2) pays the claims made under those plans. In contrast to the OAPs and PPOs, the State fully insures the HMOs, which means that the State pays each HMO a fixed fee, including a risk premium, and the HMO administers the plans and assumes all the risks and pays the claims made under each plan.

¶ 8 C. The Procedural History of This Case

¶ 9 1. The Underlying Contracts

¶ 10 Beginning in September 2010, DHFS issued requests for insurance proposals, seeking proposals from organizations to administer OAPs and/or HMOs beginning July 1, 2011. Health Alliance and Humana Health Plan, Inc. (Humana)—organizations that were administering plans for the State at that time—submitted bids to continue to administer OAPs and HMOs.

¶ 11 In April 2011, DHFS issued a notice of intent to award (1) OAP contracts to HealthLink HMO, Inc. (HealthLink), and PersonalCare Insurance of Illinois, Inc.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Edmond v. United States
520 U.S. 651 (Supreme Court, 1997)
Metz v. Department of Professional Regulation
773 N.E.2d 1234 (Appellate Court of Illinois, 2002)
Marsh v. Illinois Racing Board
689 N.E.2d 1113 (Illinois Supreme Court, 1997)
Health Alliance Medical Plans v. Department of Healthcare & Family Services
2011 IL App (4th) 110495 (Appellate Court of Illinois, 2011)
Markert v. Ryan
617 N.E.2d 1373 (Appellate Court of Illinois, 1993)

Cite This Page — Counsel Stack

Bluebook (online)
957 N.E.2d 447, 354 Ill. Dec. 131, Counsel Stack Legal Research, https://law.counselstack.com/opinion/health-alliance-medical-plans-v-dhfs-illappct-2011.