UnitedHealthcare of Pennsylvania, Inc. v. Department of Human Services

172 A.3d 98
CourtCommonwealth Court of Pennsylvania
DecidedOctober 4, 2017
Docket1978 C.D. 2016
StatusPublished
Cited by8 cases

This text of 172 A.3d 98 (UnitedHealthcare of Pennsylvania, Inc. v. Department of Human Services) 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 Pennsylvania, Inc. v. Department of Human Services, 172 A.3d 98 (Pa. Ct. App. 2017).

Opinion

OPINION BY

SENIOR JUDGE COLINS

UnitedHealthcare of Pennsylvania, Inc. (UnitedHealthcare), in this petition for review, appeals a final determination of the Department of Human Services (Department) under Section 1711.1 of the Commonwealth Procurement Code (Procurement Code), 62 Pa. C.S. § 1711.1, that denied UnitedHealthcare’s bid protest challenging the Department’s selection of offerors' for the Department’s Community HealthChoices (CHC) Program. For the reasons set forth below, we affirm.

On March 1, 2016, the Department issued Request for Proposals No. 12-15 (the RFP) to obtain competitive sealed proposals from managed care organizations (MCOs) to implement CHC, a managed care program to provide integrated physical health and long-term services and supports for older Pennsylvanians and adults with physical disabilities. (Record Item (R. Item) 13, Final Determination ¶¶ 6-8; R. Item 9 Ex. 1, RFP at 1, 42,. Reproduced Record (R.R.) at 157a, 198a.) The RFP divided the Commonwealth into five geographic zones — the Southwest, Southeast, Lehigh/Capital, Northwest and Northeast zones — and invited MCOs to submit proposals for one or more of those five zones. (R. Item 13, Final Determination 17; R. Item 9 Ex. 1, RFP at 2-5, 7, 14, R.R. at 158a-161a, 163a, 170a.) The RFP stated that the Department anticipated awarding CHC agreements-to no fewer than two and no more than five offerors for each zone. (R. Item 9 Ex. 1, RFP at 5, R.R. at 161a.)

The RFP required that the proposals contain a Technical Submittal, which was weighted as 80% of the total .points in scoring the proposals, and a Small Diverse Business '(SDB) Submittal, weighted at 20%, and offerors could receive up to 3% in bonus points for committing to Domestic Workforce Utilization. (R. Item 9 Ex. 1, RFP at 14, 38-40, R.R. at 170a, 194a-196a.) To be considered a responsible of--feror eligible for selection, an offeror was required to earn at least 70% of the available Technical Submittal points. (Id. at 40, R.R. at 196a.)

The RFP provided that the evaluation of the Technical Submittal would be based on four criteria: soundness of approach, financial condition, personnel qualifications, and • prior experience. (R. Item 9 Ex. 1, RFP at 38, R.R. at 194a.) The RFP required offerors to submit their three most recent completed years of Healthcare Effectiveness Data and Information Set (HEDIS) rates in their Technical Submit-tal. (Id. at 25-26, R.R. at 181a-182a.) The RFP provided that if the offeror operated a Pennsylvania Health Maintenance Organization (HMO), it was required to submit Pennsylvania HEDIS rates and that offerors that did not operate a Pennsylvania HMO must provide the three most recent years of HEDIS rates for an HMO that they operate in another state. (Id.) The fact that Pennsylvania offerors were required to submit Pennsylvania HEDIS rates and non-Pennsylvania offerors were to submit HEDIS rates for one state in which they operate an HMO was further confirmed on March 24, 2016 and April 5, 2016, by addenda in response to questions from offerors. (R. Item 9 Ex. 4, Addendum No. 3, R.R. at 224a, 226a; R. Item 9 Ex. 6, Addendum No. 5, R.R.: at 239a, 241a-244a.) The RFP provided that the Technical Sub-mittal would be evaluated by a committee selected by the Department and that the SDB scoring would be done by the Bureau of Diversity, Inclusion, and Small Business Opportunities (BDISBO) of the Department of General Services (DGS). (R. Item 9 Ex. 1, RFP at 8-9, 38, R.R. at 164a-Í65a, 194a.)

The deadline for submission of proposals was May 2, 2016. (R. Item 9 Ex. 5, Selection Memorandum, R.R. at 230a.) The Department received proposals for one or more zones from, a total of fourteen MCOs, consisting of eight proposals for the Southwest, zone, fourteen proposals, .for the Southeast zone, twelve proposals for the Lehigh/Capital zone, nine proposals for the Northwest zone, and nine proposals for the Northeast zone. (R. Item 13, Final Determination ¶ 18; R. Item 9 Ex. 5, Selection Memorandum, R.R. at 230a-231a.) United-Healthcare did not. file any protest with respect to the terms of the RFP and timely submitted proposals for all five zones. (R. Item 13, Final Determination ¶ ,19; ,R. Item 9 Ex. 5, Selection Memorandum, R.R. at 232ar-235a.) Following evaluation and scoring of the proposals, the Department selected Pennsylvania Health & Wellness, Inc. (PHW), Vista Health Plan, Inc. (Vista), 1 and UPMC For You, Inc. (UPMC) for contract negotiations for all five zones because their proposals achieved the three highest overall scores for each zone. (R. Item 13, Final Determination ¶ 20; R. Item 9 Ex. 5, Selection Memorandum, R.R. at 232a-237a.)

PHW, Vista, UPMC, and UnitedHealth-care all satisfied the 70% threshold on their Technical Submittals in all zones. (R. Item 9 Ex. 5, Selection Memorandum, R.R, at 232a-235a.) 2 UnitedHealthcare’s proposal was ranked fourth overall in all five zones. (Id.) United Healthcare’s technical score was’fourth highest in all five zones, below the technical scores of the three selected offerors. (Id.) United Healthcare’s SDB score was fourth highest in three zones and sixth highest in two zones, below the SDB scores of selected offerors PHW and Vista in all zones and the SDB scores of nonselected offerors with lower overall scores. (Id.) PHW, Vista, UPMC, and Uni-tedHealthcare all received the Domestic Workforce Utilization 3% bonus points in all zones. (Id.)

On August 30, 2016, the Department notified UhitedHealthcare that PHW, Vista, and UPMC had been selected for all five zones and that UnitedHealthcare was not selected for any zone. (R. Item 13, Final Determination ¶ 21; R. Item 1, Protest Ex. B, R.R. at 32a.) On September 15, 2016, the Department conducted a debriefing meeting with UnitedHealthcare at which it provided information to United-Healthcare concerning the strengths and weaknesses of its proposal and advised UnitedHealthcare that its proposal was ranked fourth in all zohes. (R. Item 13, Final Determination ¶¶ 22, 24-26; R; Item 1, Protest at 3 & Ex. I, R.R. at 7a, 47a-52a.)

On September 22, 2016, more than seven days after it was notified that it was not selected, but within seven days of the debriefing, UnitedHealthcare filed a bid protest seeking an order selecting United-Healthcare for all five zones or, in the alternative, the setting aside of the selection of PHW, Vista, and UPMC and issuance of a new solicitation of proposals. (R. Item 1, Protest at 17, R.R". at 21a.) United-Healthcare asserted five substantive grounds for this protest: a claim that the Department’s weighting of HEDIS rates in its evaluation of the proposals was unfair because UnitedHealthcare was required to submit its Pennsylvania HEDIS rates while PHW, which had no existing Pennsylvania HMO, was permitted to choose which state HEDIS rates to submit; a claim that delegation of the SDB scoring of the proposals to DGS and BDISBO was improper; and three claims concerning the qualifications of the three selected offerors. (Id. at 4-12, R.R. at 8a-16a.) UnitedHealthcare also asserted that it was, entitled :to documents that it had sought in a Right-to-Know Law (RTKL) 3

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Bluebook (online)
172 A.3d 98, Counsel Stack Legal Research, https://law.counselstack.com/opinion/unitedhealthcare-of-pennsylvania-inc-v-department-of-human-services-pacommwct-2017.