Texas Department of Insurance v. Texas Association of Health Plans

CourtCourt of Appeals of Texas
DecidedMarch 5, 2020
Docket03-19-00185-CV
StatusPublished

This text of Texas Department of Insurance v. Texas Association of Health Plans (Texas Department of Insurance v. Texas Association of Health Plans) is published on Counsel Stack Legal Research, covering Court of Appeals of Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Texas Department of Insurance v. Texas Association of Health Plans, (Tex. Ct. App. 2020).

Opinion

TEXAS COURT OF APPEALS, THIRD DISTRICT, AT AUSTIN

NO. 03-19-00185-CV

Texas Department of Insurance, Appellant

v.

Texas Association of Health Plans, Appellee

FROM THE 419TH DISTRICT COURT OF TRAVIS COUNTY NO. D-1-GN-18-003846, THE HONORABLE DARLENE BYRNE, JUDGE PRESIDING

OPINION

In this interlocutory appeal, the Texas Department of Insurance (the Department)

challenges the trial court’s denial of the Department’s plea to the jurisdiction on two claims

brought by the Texas Association of Health Plans (the Association): (1) a claim under the

Administrative Procedure Act (APA), see Tex. Gov’t Code § 2001.038, seeking to invalidate

certain Department rules as “invalid exercises of [the Department’s] statutory authority” to

regulate certain health plans (the APA Claim); and (2) an alternative claim under the Uniform

Declaratory Judgments Act (UDJA), see Tex. Civ. Prac. & Rem. Code §§ 37.001–.011, seeking

to invalidate certain Texas Insurance Code provisions that “authoriz[e] out of network payments

at ‘usual and customary rates’” as “unconstitutional delegations of state authority to self-

interested private entities” (the UDJA Claim). The Department argues that sovereign immunity

bars these claims. We disagree and affirm. BACKGROUND

The Association is “a not-for-profit trade association representing the legal and

financial interests of licensed Texas health insurers, health maintenance organizations (HMOs)

and other health plans licensed to operate in Texas” with a mission to “improve healthcare in

Texas, including by improving the value and cost-effectiveness of healthcare services covered by

its members’ plans.” In 2018, the Association sued the Department, raising its APA Claim and

alternatively its UDJA Claim, asserting associational standing to bring claims on behalf of its

members, and claiming that section 2001.038 waives sovereign immunity as to its APA Claim.

The Department filed a plea to the jurisdiction, asserting that sovereign immunity barred the

APA and UDJA Claims and challenging the Association’s standing to bring the claims on behalf

of its members. At an evidentiary hearing, the Association submitted affidavits from its

members supporting associational standing, and the Department does not challenge the

Association’s standing in this interlocutory appeal. Following the hearing, the trial court denied

the Department’s plea to the jurisdiction. The Department timely appealed the order.

STANDARD OF REVIEW

“Procedurally, the assertion of sovereign immunity implicates the trial court’s

jurisdiction and is properly asserted in a plea to the jurisdiction.” PHI, Inc. v. Texas Juvenile

Justice Dep’t, No. 18-0099, ___ S.W.3d ___, 2019 WL 1873431, at *3 (Tex. Apr. 26, 2019)

(citing Houston Belt & Terminal Ry. v. City of Houston, 487 S.W.3d 154, 160 (Tex. 2016); Rusk

State Hosp. v. Black, 392 S.W.3d 88, 91 (Tex. 2012)). When a plea challenges the pleadings, we

determine if the pleader has alleged facts that affirmatively demonstrate the court’s jurisdiction

to hear the case, construing the pleadings liberally in favor of the plaintiffs and looking to the

2 pleaders’ intent. Houston Belt & Terminal Ry., 487 S.W.3d at 160 (quoting City of El Paso

v. Heinrich, 284 S.W.3d 366, 378 (Tex. 2009)). When the relevant jurisdictional facts are

undisputed, as they are here, “the trial court rules on the plea to the jurisdiction as a matter of

law.” PHI, ___ S.W.3d at ___, 2019 WL 1873431, at *3 (quoting Texas Dep’t of Parks &

Wildlife v. Miranda, 133 S.W.3d 217, 227–28 (Tex. 2004)). We review the trial court’s ruling

on the plea de novo. See id.

DISCUSSION

The Department raises two issues on appeal. First, the Department argues that

sovereign immunity bars the Association from asserting its APA Claim. According to the

Department, “section 2001.038 [] limits who may invoke its waiver of immunity” and does not

waive sovereign immunity for a claim brought by an association to challenge the Department’s

rules on behalf of its members because the provision requires an allegation “that the rule or its

threatened application interferes with or impairs, or threatens to interfere with or impair, a legal

right or privilege of the plaintiff.” Tex. Gov’t Code § 2001.038(a) (emphasis added). Second,

although the UDJA waives sovereign immunity for constitutional challenges to statutes, the

Department argues that the UDJA Claim is in effect a statutory construction claim that is barred

by the redundant remedies doctrine and that even if it is a constitutional challenge to the statute,

the Association did not sufficiently plead a viable constitutional claim.

The APA Claim

The parties agree that section 2001.038 of the Texas Government Code is the only

possible statutory basis for a waiver of the Department’s sovereign immunity as to the

Association’s rule challenge in its APA Claim. In interpreting a statutory provision to determine

3 whether the legislature has waived sovereign immunity, we look to the text of the statute at issue

to determine whether it contains a clear and unambiguous expression of waiver. See Wichita

Falls State Hosp. v. Taylor, 106 S.W.3d 692, 696 (Tex. 2003) (“It is settled in Texas that for the

Legislature to waive the State’s sovereign immunity, a statute or resolution must contain a clear

and unambiguous expression of the Legislature’s waiver of immunity.”); see also Tex. Gov’t

Code § 311.034 (“In order to preserve the legislature’s interest in managing state fiscal matters

through the appropriations process, a statute shall not be construed as a waiver of sovereign

immunity unless the waiver is effected by clear and unambiguous language.”). Here, the

relevant statute reads:

The validity or applicability of a rule, including an emergency rule adopted under Section 2001.034, may be determined in an action for declaratory judgment if it is alleged that the rule or its threatened application interferes with or impairs, or threatens to interfere with or impair, a legal right or privilege of the plaintiff.

Tex. Gov’t Code § 2001.038(a). The Department does not dispute that “section 2001.038 is a

grant of original jurisdiction and, moreover, waives sovereign immunity,” Machete’s Chop Shop,

Inc. v. Texas Film Comm’n, 483 S.W.3d 272, 286 (Tex. App.—Austin 2016, no pet.) (quoting

Texas Logos, L.P. v. Texas Dep’t of Transp., 241 S.W.3d 105, 123 (Tex. App.—Austin 2007, no

pet.)), as to a suit brought by a plaintiff alleging that a rule interferes with or impairs its legal

right or privilege. And the Department agrees that an association can challenge a rule under

section 2001.038 if the association alleges interference with or impairment of the association’s

legal right or privilege. But, in what appears to be a novel interpretation of section 2001.038, the

Department claims that the scope of the sovereign immunity waiver does not extend to an

associational plaintiff alleging interference with or impairment of its members’ legal rights or

privileges. We disagree.

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