Vista Health Plan, Inc. v. DHS

CourtCommonwealth Court of Pennsylvania
DecidedApril 11, 2018
Docket820 C.D. 2017
StatusUnpublished

This text of Vista Health Plan, Inc. v. DHS (Vista Health Plan, 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
Vista Health Plan, Inc. v. DHS, (Pa. Ct. App. 2018).

Opinion

IN THE COMMONWEALTH COURT OF PENNSYLVANIA

Vista Health Plan, Inc., : : Petitioner : : v. : No. 820 C.D. 2017 : Argued: October 18, 2017 Department of Human Services, : : Respondent :

BEFORE: HONORABLE MARY HANNAH LEAVITT, President Judge HONORABLE ROBERT SIMPSON, Judge HONORABLE P. KEVIN BROBSON, Judge HONORABLE PATRICIA A. McCULLOUGH, Judge HONORABLE ANNE E. COVEY, Judge HONORABLE MICHAEL H. WOJCIK, Judge HONORABLE ELLEN CEISLER, Judge1

OPINION NOT REPORTED

MEMORANDUM OPINION BY JUDGE WOJCIK FILED: April 11, 2018

Vista Health Plan, Inc. (Vista) petitions for review of the order of the Department of Human Services (Department)2 denying Vista’s bid protests

1 This case was argued before an en banc panel of the Court that included former Judge Joseph M. Cosgrove. Because Judge Cosgrove’s service on the Court ended January 1, 2018, this matter was submitted on briefs to Judge Ellen Ceisler as a member of the en banc panel.

2 Pursuant to Section 201 of the Administrative Code of 1929, Act of April 9, 1929, P.L. 177, as amended, 71 P.S. §61(a), “[t]he executive and administrative work of this Commonwealth shall be performed by the Executive Department, consisting of the . . . Department of Public Welfare . . . .” Pursuant to Section 103(a) of the Act of June 13, 1967, P.L. 31, added by the Act challenging the Department’s decision not to select Vista to progress to agreement negotiations in certain zones with respect to reissued Request for Proposal No. 06- 15 (Reissued RFP) in which the Department sought managed care organizations (MCOs) to provide HealthChoices Physical Health Program (HealthChoices) services to Medical Assistance (MA) beneficiaries.3 We reverse.

of September 24, 2014, P.L. 2458, 62 P.S. §103(a), “[t]he Department of Public Welfare shall be known as the Department of Human Services.”

3 As this Court has explained:

[The Department], formerly known as the Department of Public Welfare (DPW), is the state agency that administers the Commonwealth’s Medicaid program. “Medicaid is a joint state- federal funded program for [MA] in which the federal government approves a state plan for the funding of medical services for the needy and then subsidizes a significant portion of the financial obligations the state agreed to assume.” [The Department] delivers Medicaid benefits in Pennsylvania through either (1) a “fee for service” payment program, where the provider of care is paid by [the Department] on a claim-by-claim basis; or (2) a “managed care” program where [an MCO], under contract with [the Department], is paid on a monthly, fixed-fee basis per enrollee, and the MCO pays the provider pursuant to the terms of an agreement between the MCO and the provider. Pennsylvania’s Medicaid managed-care program is HealthChoices.

***

Section 443.5 of the Human Services Code, Act of June 13, 1967, P.L. 31, added by the Act of July 15, 1976, P.L. 993, 62 P.S. §443.5, relating to prepayment for contracted medical services, authorizes [the Department] to enter into contracts with insurers, such as MCOs, through a competitive bidding process. Section 443.5 of the Human Services Code provides, in relevant part: For categorically needy or medically needy persons eligible for medical assistance, prepaid capitation payments or insurance premiums for services under

2 Under the HealthChoices Program, the Department contracts with MCOs to administer health services to those eligible for Medicaid in five “Zones,” Northeast, Southeast, Lehigh-Capital, Southwest, and Northwest. Currently, Vista operates as an MCO in the Southeast, Lehigh/Capital, Northeast, and Northwest Zones. On September 16, 2015, the Department issued Request for Proposal No. 06-16 (Original RFP) seeking MCOs to administer HealthChoices in all five Zones beginning in 2017. The Original RFP stated that the Department would award three-year contracts to up to five MCOs in each Zone and identified the following criteria: (1) technical criteria comprising 80% of the total points; (2) Small Diverse Business Participation with a weight of 20% of the total points; and (3) Domestic Workforce Utilization consisting of “bonus points” to a maximum of 3% of the total points. To qualify as a responsible offeror, the Original RFP stated that an MCO’s technical submission must receive a total score of at least 70% of the available points allotted in the evaluation. On July 21, 2016, the Department issued the Reissued RFP again seeking MCOs to provide HealthChoices services to MA beneficiaries in the five Zones.4 The Reissued RFP provides for agreements with a three-year term with an

the medical assistance State plan may be made on behalf of eligible persons through competitive bidding with profit or non-profit contractors, insurers, or health maintenance organizations. Profit and non-profit insurers must be approved under applicable State laws. (Emphasis added.)

Aetna Better Health of Pennsylvania Inc. v. Department of Human Services, (Pa. Cmwlth., No. 351 M.D. 2016, filed July 6, 2016), slip op. at 1-3 n.1, 2 (citations omitted). 4 See Section 521 of the Procurement Code, 62 Pa. C.S. §521 (“[A] request for proposals or other solicitation may be canceled . . . at any time prior to the time a contract is executed by all

3 option for one additional renewal two-year term. The Department’s Bureau of Financial Operations, Division of Procurement and Contract Management was the Issuing Office of the Reissued RFP, and “[t]he sole point of contact in the Commonwealth for th[e Reissued] RFP” is Erin Slabonik, the Project Officer for the Reissued RFP. Reproduced Record (R.R.) at 45a. Initially, the Reissued RFP did not provide for a bid protest mechanism; however, the Department issued Addendum 1 to the Reissued RFP which states that “[i]n the event an Offeror elects to file a bid protest, the Department will accept the bid protest. The Department will address the merits of the bid protest if the bid protest is timely filed.” R.R. at 88a. The Reissued RFP states that the following criteria was to be used to evaluate the proposals: (1) technical criterion based on a Work Statement Questionnaire/Soundness of Approach, Personnel Qualifications and Staffing, and Prior Experience and Performance (80% or 8,000 of the possible 10,000 total points); (2) Small Diverse Business and Small Business (SDB/SB) Participation as determined by the Department of General Services’ (DGS) Bureau of Diversity, Inclusion and Small Business Opportunities (BDISBO) (20% or 2,000 of the possible 10,000 total points); and (3) Domestic Workforce Utilization bonus points (up to 3% of the possible 10,000 total points). R.R. at 79a-81a. In order to be considered a responsible offeror, “and therefore eligible for selection for agreement

parties when it is in the best interests of the Commonwealth. . . . The reasons for the cancellation or rejection shall be made part of the contract file.”). See also Scientific Games International, Inc. v. Department of Revenue, 66 A.3d 740, 758 (Pa. 2013) (“The Legislature has deliberately excluded Section 521 cancellations from the scope of the right of protest. See 62 Pa. C.S. §1711.1(a) (prescribing that bidders, offerors, and certain others “aggrieved in connection with the solicitation or award of a contract, except as provided in section 521 (relating to cancellation of invitations for bids or requests for proposals), may protest to the head of the purchasing agency in writing” (emphasis added)).”). 4 negotiations,” the total score for the technical submission in a proposal for each Zone “must be greater than or equal to 75% of the available technical points.” Id. at 81a.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

American Totalisator Co., Inc. v. Seligman
414 A.2d 1037 (Supreme Court of Pennsylvania, 1980)
Peoples Natural Gas Co. v. Pennsylvania Public Utility Commission
542 A.2d 606 (Commonwealth Court of Pennsylvania, 1988)
Adams Outdoor Adv., Lp. v. Zoning Hearing Bd. of Smithfield Township
909 A.2d 469 (Commonwealth Court of Pennsylvania, 2006)
Language Line Services, Inc. v. Department of General Services
991 A.2d 383 (Commonwealth Court of Pennsylvania, 2010)
Hoffman Mining Co. v. Zoning Hearing Board
32 A.3d 587 (Supreme Court of Pennsylvania, 2011)
Stapleton v. Berks County
593 A.2d 1323 (Commonwealth Court of Pennsylvania, 1991)
Harris v. Philadelphia
129 A. 460 (Supreme Court of Pennsylvania, 1925)
Stanton-Negley Drug Co. v. Department of Public Welfare
943 A.2d 377 (Commonwealth Court of Pennsylvania, 2008)
Hanisco v. Township of Warminster
41 A.3d 116 (Commonwealth Court of Pennsylvania, 2012)
Wyland v. West Shore School District
52 A.3d 572 (Commonwealth Court of Pennsylvania, 2012)
Scientific Games International, Inc. v. Commonwealth
66 A.3d 740 (Supreme Court of Pennsylvania, 2013)
Harmer v. Pennsylvania Board of Probation & Parole
83 A.3d 293 (Commonwealth Court of Pennsylvania, 2014)
Conduit & Foundation Corp. v. City of Philadelphia
401 A.2d 376 (Commonwealth Court of Pennsylvania, 1979)
Peoples Natural Gas Co. v. Pennsylvania Public Utility Commission
529 A.2d 1176 (Commonwealth Court of Pennsylvania, 1987)

Cite This Page — Counsel Stack

Bluebook (online)
Vista Health Plan, Inc. v. DHS, Counsel Stack Legal Research, https://law.counselstack.com/opinion/vista-health-plan-inc-v-dhs-pacommwct-2018.