PA Health & Wellness, Inc. v. DHS

CourtCommonwealth Court of Pennsylvania
DecidedNovember 17, 2021
Docket1107 C.D. 2020 & 2 C.D. 2021
StatusUnpublished

This text of PA Health & Wellness, Inc. v. DHS (PA Health & Wellness, Inc. v. DHS) 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
PA Health & Wellness, Inc. v. DHS, (Pa. Ct. App. 2021).

Opinion

IN THE COMMONWEALTH COURT OF PENNSYLVANIA

Pennsylvania Health and : Wellness, Inc., : Petitioner : : v. : : Department of Human Services, : Nos. 1107 C.D. 2020 & 2 C.D. 2021 Respondent : Argued: October 18, 2021

BEFORE: HONORABLE PATRICIA A. McCULLOUGH, Judge HONORABLE MICHAEL H. WOJCIK, Judge HONORABLE CHRISTINE FIZZANO CANNON, Judge

OPINION NOT REPORTED

MEMORANDUM OPINION BY JUDGE FIZZANO CANNON FILED: November 17, 2021

Pennsylvania Health & Wellness, Inc. (PHW) has filed petitions for review of two Final Determinations (jointly, Final Determination) by the Secretary of Human Services (Secretary)1 of the Pennsylvania Department of Human Services (Department) denying PHW’s bid protests under Request for Applications 07-19 (RFA) relating to the Commonwealth’s HealthChoices Medicaid (HealthChoices) Program. The petitions have been consolidated for disposition by this Court. On review, we affirm the Secretary’s Final Determination.

1 For purposes of the Final Determination, the Secretary of Human Services (Secretary) of the Department of Human Services (Department) appointed a designee, Jonathan Rubin, Deputy Secretary of the Department’s Office of Children, Youth and Families. Final Determination, October 20, 2020 (Final Determination 1) at 23. For ease of reference, this opinion refers to the designee as the Secretary and the designee’s Final Determination as that of the Secretary. I. Background HealthChoices 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. The Department contracts with multiple MCOs to administer HealthChoices Program benefits and services in each zone. PHW is a wholly-owned subsidiary of Centene Corporation, the largest Medicaid MCO in the United States. Since its founding in 2015, PHW has participated in all of the Department’s procurement processes regarding the HealthChoices Program. PHW has served as a contracted MCO in a separate program, Community HealthChoices (CHC), since January 2018. In September 2015, the Department issued Request for Proposals (RFP) 06-15 to begin the process of entering into new contracts for administration of the HealthChoices Program in all five zones. PHW submitted a proposal for all five zones. In April 2016, the Department accepted PHW for negotiations to provide service in three zones. However, in a lawsuit by another applicant, this Court enjoined negotiation or implementation of contract awards on RFP 06-15, based on the Department’s use of an undisclosed “heritage factor” in its evaluations that favored MCOs with current contracts. See Aetna Better Health of Pa., Inc. v. Dep’t of Hum. Servs. (Pa. Cmwlth., No. 351 M.D. 2016, filed July 19, 2016), slip op. at 32, 2016 Pa. Commw. Unpub. LEXIS 1120 (unreported). The Department then withdrew RFP 06-15 and reissued it as “RFP 06- 15 (Reissued).” PHW again submitted a proposal for all five zones. In November 2016, the Department accepted PHW for negotiations in all 5 zones. However, the Department rescinded its selections the next day because of a scoring error and then

2 rescored the proposals. In December 2016, the Department notified PHW of its acceptance for negotiations in three zones. However, in April 2018, all negotiations were cancelled after successful protests of RFP 06-15 (Reissued), where this Court concluded that the Department’s discussions with MCOs about bid modifications and readiness review violated the RFP and the Commonwealth Procurement Code (Procurement Code)2 because only the Department’s designated Issuing Officer, Karen Kern (Kern), may engage in such discussions. UnitedHealthcare of Pa., Inc. v. Dep’t of Hum. Servs. (Pa. Cmwlth., No. 790 C.D. 2017, filed Apr. 10, 2018), slip op. at 27, 2018 Pa. Commw. Unpub. LEXIS 212, at *31-32 (unreported). Meanwhile, in January 2018, after being selected under a separate March 2016 RFP, PHW began providing services in the Department’s CHC Program, which serves participants with dual eligibility for Medicaid and Medicare. PHW developed a network of providers and partners with community groups to serve participants in the CHC Program. In October 2019, the Department issued the RFA in a third attempt to seek new contracts regarding administration of the HealthChoices Program. PHW submitted an application for four zones. The Department did not select PHW for negotiations in any of those zones. PHW filed five bid protests; four were consolidated and the fifth proceeded separately. The Secretary disposed of the bid protests in two determinations issued October 23, 2020 (Final Determination 1), and December 18, 2020 (Final Determination 2).3

2 62 Pa. C.S. §§ 101-2311. 3 Final Determination 2 incorporated by reference all arguments asserted in PHW’s fifth bid protest that had already been addressed in Final Determination 1. Br. of Pet’r, Ex. B, Final

3 In the Final Determination, the Secretary rejected PHW’s argument that the Department was biased against PHW because of PHW’s expressions of concern regarding pricing issues in its CHC contract. Br. of Pet’r, Ex. B (Final Determination) at 7-8. The Secretary also rejected PHW’s contention that the Department improperly based its evaluation of PHW’s application on undisclosed criteria. Id. at 8-9 & 15-20. The Secretary further determined PHW had failed to prove its assertion that the Department had improper contacts with applicants concerning the RFA after the application due date. Id. at 10-11. The Secretary likewise concluded PHW had not established that the Department changed its readiness review process or that the alleged change would have violated the RFA. Id. at 11-12. Additionally, the Secretary rejected PHW’s argument that the Department’s debriefing documents showed it misread PHW’s application and evaluated competing applicants inconsistently. Id. at 14-15 & 20-22. Finally, the Secretary refused PHW’s request for an evidentiary hearing, finding the record was sufficient to allow issuance of a determination. Id. at 23. PHW then filed its petitions for review. Several other applicants have intervened in this matter.4 Briefing and argument are complete and the consolidated petitions are ready for disposition.

Determination 2 at 5. PHW has not raised here any issues the Secretary addressed separately in Final Determination 2. Therefore, for convenience, this opinion addresses all issues in relation to Final Determination 1. We note that Final Determination 1 also included some issues that PHW has not raised in its petition for review before this Court and that are not addressed here. 4 The intervenors are Aetna Better Health of Pennsylvania, Inc., Gateway Health Plan, Inc., Geisinger Health Plan, Inc., Health Partners Plans, UnitedHealthcare of Pennsylvania, Inc., UPMC For You, Inc., and (jointly) Vista Health Plan, Inc., AmeriHealth Caritas Health Plan, and Keystone Family Health Plan. 4 II. Issues On appeal,5 PHW argues the Final Determination was arbitrary and capricious and an abuse of discretion, and the Department failed to comply with the RFA, the Procurement Code, and the Procurement Handbook.6 First, PHW alleges bias by the Department. PHW asserts that it has a successful record of providing CHC Program services in Pennsylvania, but the Department became critical of PHW as an MCO after PHW complained about CHC rates and eligibility during the period when the Department was considering applications under the RFA in the first half of 2020. PHW provided a sworn declaration that it received what it considered to be “veiled threats” from the former Deputy Secretary of the Department’s Office of Long-Term Living (OLTL) implying that continuing its complaints could hurt its position as an applicant under the RFA. Br. of Pet’r at 15-16 (citing Reproduced Record (RR) 66a-67a).

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Bluebook (online)
PA Health & Wellness, Inc. v. DHS, Counsel Stack Legal Research, https://law.counselstack.com/opinion/pa-health-wellness-inc-v-dhs-pacommwct-2021.