UnitedHealthcare of PA, Inc. v. DHS (OOR)

CourtCommonwealth Court of Pennsylvania
DecidedDecember 15, 2022
Docket245 C.D. 2021
StatusUnpublished

This text of UnitedHealthcare of PA, Inc. v. DHS (OOR) (UnitedHealthcare of PA, Inc. v. DHS (OOR)) 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
UnitedHealthcare of PA, Inc. v. DHS (OOR), (Pa. Ct. App. 2022).

Opinion

IN THE COMMONWEALTH COURT OF PENNSYLVANIA

UnitedHealthcare of Pennsylvania, Inc., : : Petitioner : : v. : No. 245 C.D. 2021 : Argued: February 7, 2022 Department of Human Services : (Office of Open Records), : : Respondent :

BEFORE: HONORABLE MICHAEL H. WOJCIK, Judge HONORABLE CHRISTINE FIZZANO CANNON, Judge HONORABLE LORI A. DUMAS, Judge

OPINION NOT REPORTED

MEMORANDUM OPINION BY JUDGE WOJCIK FILED: December 15, 2022

In this appeal, UnitedHealthcare of Pennsylvania (United) petitions for review of the Final Determination of the Office of Open Records (OOR) denying its appeal of its request for records from the Pennsylvania Department of Human Services (DHS) under the provisions of the Right-to-Know Law (RTKL).1 After careful review, we affirm.

I. In order to understand the claims raised in the instant appeal, a brief recounting of a number of related cases is necessary. This Court has recently noted:

1 Act of February 14, 2008, P.L. 6, 65 P.S. §§67.101-67.3104. [The HealthChoices Medicaid (HealthChoices) Program] is Pennsylvania’s mandatory managed care program for physical health services to Medicaid participants. Managed care providers (MCOs) administer the HealthChoices Program in five Pennsylvania zones - Northeast, Southeast, Lehigh-Capital, Northwest, and Southwest. [DHS] contracts with multiple MCOs to administer HealthChoices Program benefits and services in each zone. United is one of those MCOs.

***

In September 2015, [DHS] issued Request for Proposals (RFP) 06-15 for new contracts for administration of the HealthChoices Program in all five zones. United submitted a proposal for all five zones. However, [DHS] did not select United to negotiate for new contracts.

United claim[ed that DHS] stated that in evaluating applications under RFP 06-15, it applied what it called a “heritage factor” in evaluating the proposals by all applicants. See Aetna Better Health of P[ennsylvani]a, Inc. v. Dep[artmen]t of Hum[an] Serv[ice]s (Pa. Cmwlth., No. 351 M.D. 2016, filed July 19, 2016), slip op. at 4-5[.] [DHS] applied the heritage factor to favor any existing contractor MCO having at least a 25% market share of Medicaid participants, reasoning that the disruption likely to arise from cessation of such an applicant’s services would outweigh some shortfall in the rest of the applicant’s evaluation scores. Id. However, [DHS] did not disclose in the RFP that it would be applying the heritage factor as part of its evaluation process.

Another applicant, Aetna Better Health of Pennsylvania, Inc. (Aetna), filed a bid protest alleging the heritage factor was a secret criterion used to deprive Aetna of new contracts and to favor other MCOs despite Aetna’s higher proposal scores. [DHS] responded by asserting that Aetna could not protest based on that issue. Aetna then filed a petition for review. This Court enjoined the RFP 06-15 procurement and ordered that if [DHS] chose to review Aetna’s bid protest, that review should be by an 2 independent hearing officer not employed by [DHS] and not connected to the RFP. See Aetna Better Health, slip op. at 32.

[DHS] then withdrew RFP 06-15 and reissued it as RFP 06-15 (Reissued). United again submitted a proposal. Whether [DHS] applied the heritage factor again is unclear. However, United and other applicants filed bid protests to RFP 06-15 (Reissued), claiming that [DHS] had again applied the heritage factor in a manner designed to favor the MCOs that previously received contracts with [DHS], and that [DHS] had secret discussions with another MCO about modifying its bid proposal in order to pass [DHS’s] readiness review procedure. [DHS] denied the bid protests. This Court reversed [DHS], concluding that discussions with MCOs about bid modifications and readiness review violated the RFP and the Commonwealth Procurement Code (Procurement Code)[2] because only [DHS’s] designated Issuing Officer, Karen Kern [(Kern)], may engage in such discussions. See UnitedHealthcare of P[ennsylvani]a, Inc. v. Dep[artmen]t of Human Serv[ice]s (Pa. Cmwlth., No. 790 C.D. 2017, filed Apr[il] 10, 2018), slip op. at 27[.]

In October 2019, [DHS] issued [Request for Applications 07-19 (RFA)] pursuant to the Procurement Code seeking applications for new contracts to administer the HealthChoices Program. United submitted an application for all five zones. In July 2020, [DHS] notified United that it had selected United for negotiations only in the Southeast zone. United requested a debriefing as provided under the RFA and the Commonwealth’s Procurement Handbook.

United filed a series of bid protests, which were later consolidated. On February 17, 2021, the [Secretary of Human Services (Secretary)] issued the Final Determination denying United’s bid protests. United filed

2 62 Pa. C.S. §§101-2311. 3 a petition for review in this Court. Several competing applicants under the RFA [] intervened in th[e] matter. UnitedHealthcare of Pennsylvania, Inc. v. Department of Human Services (Pa. Cmwlth., No. 165 C.D. 2021, filed November 17, 2021), slip op. at 2-4 (footnotes omitted). Ultimately, this Court affirmed the Secretary’s Final Determination denying United’s bid protests under the RFA and the Procurement Code. Id.

II. With respect to the instant appeal, on September 18, 2020, United filed a request with DHS under the RTKL (Second Request)3 seeking the following relevant documents: (1) communications with any applicant related to the RFA; (2) any documents or communications related to the readiness-review process described in the RFA; (3) any documents or communications related to DHS’s decision to extend the incumbent HealthChoices Program for up to two years; (4) any documents or communications, both internal and external, related to debriefing requests by any RFA applicant; (5) any documents or communications, both internal and external, related to Contractor Partnership Program (CPP) submittals under the RFA, including copies of each applicants’ CPP submittal and any review or assessment of such submittals by DHS; (6) any documents or communications between DHS and any corporate reference for an applicant under the RFA; and (7) any documents produced by DHS since July 2, 2020, in response to a RTKL request

3 United had submitted a prior request with DHS under the RTKL (First Request). United’s appeal with respect to the proceedings involving the First Request is docketed in this Court at No. 1117 C.D. 2020. See UnitedHealthcare of Pennsylvania, Inc. v. Pennsylvania Department of Human Services (Office of Open Records) (Pa. Cmwlth., No. 1117 C.D. 2020, filed December 15, 2022). The instant appeal and that appeal were not consolidated, but were argued seriately before this Court. 4 by any organization that also submitted an application in response to the RFA. See OOR Docket No. 2020-2750 Exhibit 1 at Exhibit A. On November 2, 2020, DHS responded to the Second Request. For Item 1, DHS granted the request in part and denied it in part. DHS provided copies of communications with any applicant since July 2, 2020, but redacted proposal and evaluation information that is exempt under Section 708(b)(26) of the RTKL, and personal identification information that is exempt under Section 708(b)(6)(i)(A). OOR Docket No. 2020-2750 Exhibit 1 at 16-17. With respect to Item 2, DHS noted that the readiness-review process had not yet begun because of pending procurement protests, but it would provide responsive records with redacted personal identification information under Section 708(b)(6)(i)(A); redacted predecisional deliberations that are exempt under Section 708(b)(10)(i)(A); redacted information subject to the attorney-client privilege that is excluded from the definition of a “public record” under Section 102 of the RTKL; and information that is excluded under the attorney work-product doctrine.4 OOR Docket No. 2020-2750 Exhibit 1 at 17.

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UnitedHealthcare of PA, Inc. v. DHS (OOR), Counsel Stack Legal Research, https://law.counselstack.com/opinion/unitedhealthcare-of-pa-inc-v-dhs-oor-pacommwct-2022.