UnitedHealthcare Insurance Company and Sierra Health and Life Insurance Company, Inc. v. Ken Paxton, Attorney General of Texas Teacher Retirement System of Texas Humana Insurance Company Humana Insurance Company of New York And Humana Insurance Company of Puerto Rico, Inc.

Court of Appeals of Texas·Decided May 3, 2024·No. 03-22-00198-CV·Published

Opinion

TEXAS COURT OF APPEALS, THIRD DISTRICT, AT AUSTIN

NO. 03-22-00198-CV

UnitedHealthcare Insurance Company and Sierra Health and Life Insurance Company, Inc., Appellants

v.

Ken Paxton, Attorney General of Texas; Teacher Retirement System of Texas;

Humana Insurance Company; Humana Insurance Company of New York; and Humana Insurance Company of Puerto Rico, Inc., Appellees

FROM THE 53RD DISTRICT COURT OF TRAVIS COUNTY NO. D-1-GN-21-002888, THE HONORABLE LORA J. LIVINGSTON, JUDGE PRESIDING

OPINION

UnitedHealthcare Insurance Company and Sierra Health and Life Insurance Company (collectively, United) appeal from the district court’s final judgment denying United’s request for a declaration under the Texas Public Information Act (PIA). See Tex. Gov’t Code §§ 552.001–.353. United filed suit to prevent disclosure of information related to a contract between United and Teacher Retirement System of Texas (TRS) concerning TRS’s Texas School Retired Employees Group Benefits program (TRS-Care), which serves eligible retirees of TRS’s pension program and their dependents. The district court entered final judgment which denied United’s requested relief and compelled TRS to produce the requested documents. For the following reasons, we affirm.

BACKGROUND

This subject of this appeal is a contract between United and TRS (the Contract).

TRS is a state-authorized trustee that administers TRS-Care, a program that serves eligible retirees who participate in TRS’s pension program and their dependents. In July 2019, TRS issued a request for proposal to solicit proposals from vendors to provide a fully insured Medicare Advantage plan for eligible TRS-Care participants. Both United and Humana Insurance Company (Humana) submitted bids. 1 After all proposals were submitted, TRS issued two best and final offer (BAFO) requests—one of which contained a request for gain sharing. The BAFO that requested gain sharing asked the finalist vendors to either “(1) provide the shared savings payment in excess of the TRS premium or (2) hold any shared savings in excess of premium into an account to be used for future premium offsets.” Humana believed the request for gain sharing violated federal law, and in response, notified TRS. After receiving the BAFO response from United, TRS requested that “[United’s] legal certify your response to these questions.” United’s lawyer responded that its legal team was satisfied that its “offer was structured in a way that complied with all applicable laws.”

In February 2020, TRS awarded the contract to United. The Contract between United and TRS consists of the Contract itself, along with various exhibits. The Contract states that the TRS-Care program is to be funded by a trust; and amounts are paid into the trust by the State of Texas, public schools, active teachers, and participants of the program. The trust is defined under the Contract as “the Retired School Employees Group Insurance Fund established under Chapter 1575, Texas Insurance Code.” United’s role under the Contract is to provide fully insured

1 “Humana” includes Humana Insurance Company, Humana Insurance company of New York, and Humana Insurance of Puerto Rico, Inc.

Medicare Advantage plan coverage under the program for Medicare-eligible participants enrolled in TRS-Care. United claims that it receives funds from the federal Center for Medicaid Services (CMS) and that those funds are what are used to pay member claims.

After learning that TRS awarded the contract to United, Humana filed a bid contest, which TRS denied. In March 2021, Humana served TRS with a request for documents under the Texas Public Information Act (PIA), seeking:

(1) A copy of the final executed contract between TRS and United for TRS-Care Medicare Advantage plan for services commencing on or about January 1, 2021 (the Contract), including exhibits;

(2) Unredacted copies of BAFO requests and responses between TRS and United relating to request for proposals No. 19-

0000184, including specifically any “legal certifications;”

(3) contract or offer terms or their functional equivalent in the Contract that are identified in sections A through J of Tex. Gov’t Code § 552.0222(b)(3); and

(4) offer terms or their functional equivalent made by United in response to Request for Proposals No. XX-XXXXXXX that are identified in sections A through J of Tex. Gov’t Code § 552.0222(b)(3).

In response to Humana’s request, TRS submitted a request for an Attorney General decision without asserting any exceptions to disclosure on its own behalf. See Tex. Gov’t Code § 552.301(a) (governmental body that receives written request for information it wishes to withhold under specific exception must ask for decision from attorney general about whether information is within that exception). Both United and Humana submitted extensive briefing to the Attorney General in which United asserted that the information sought was excepted from disclosure under section 552.110 and section 552.1101 of the PIA. See Tex. Gov’t Code

§§ 552.110(a), (b), (c) .110 (trade secrets; commercial or financial information that if released will cause substantial competitive harm); 552.1101(a) (confidentiality of proprietary information). In support, United submitted an affidavit of Craig Condon that explained how and why United believed the relevant exceptions applied to the requested information.

After considering the briefing of the parties, the Attorney General issued Order OR2021-15157 (AG Order), directing TRS to:

(1) Withhold information that the Attorney General identified as applicable under section 552.110(c) (with the exception of United’s client information that is publicly available on its website) [and]

(2) Disclose the remaining information.

Put simply, the Attorney General found that some of the information could be withheld on the basis of section 552.110(c) (commercial or financial information that if released will cause substantial competitive harm), while disclosure of the remaining requested information was warranted because either (1) it was contracting information under section 552.0222 to which the exceptions asserted by United did not apply, or (2) United failed to submit sufficient evidence to meet its burden in establishing an exception. After receiving the Order, United filed the underlying suit seeking a declaration under the Uniform Declaratory Judgments Act (UDJA) that the requested information was not subject to disclosure because it fell within various exceptions under the PIA. Humana timely intervened. See id. § 552.325(a). United and Humana filed cross-motions for traditional summary judgment. Both parties’ respective motions contained the same evidence that was provided to the Attorney General in the parties’ letter briefings. After conducting a hearing on the motions and an in-camera review of the information at issue, the district court granted Humana’s motion for summary judgment, denied United’s motion for summary judgment,

affirmed the Attorney General’s ruling in AG Order 2021-15157, and ordered TRS to produce the information in accordance with the AG Order. 2 United timely appealed.

STANDARD OF REVIEW

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UnitedHealthcare Insurance Company and Sierra Health and Life Insurance Company, Inc. v. Ken Paxton, Attorney General of Texas Teacher Retirement System of Texas Humana Insurance Company Humana Insurance Company of New York And Humana Insurance Company of Puerto Rico, Inc., (Tex. Ct. App. 2024).

UnitedHealthcare Insurance Company and Sierra Health and Life Insurance Company, Inc. v. Ken Paxton, Attorney General of Texas Teacher Retirement System of Texas Humana Insurance Company Humana Insurance Company of New York And Humana Insurance Company of Puerto Rico, Inc. (UnitedHealthcare Insurance Company and Sierra Health and Life Insurance Company, Inc. v. Ken Paxton, Attorney General of Texas Teacher Retirement System of Texas Humana Insurance Company Humana Insurance Company of New York And Humana Insurance Company of Puerto Rico, Inc.) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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