Searching over 5,500,000 cases.


searching
Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.

Health Alliance Medical Plans, Inc., Illinois Domestic Stock Insurance Corporation, of v. the Department of Healthcare and Family Services; Julie Hamos

August 3, 2011

HEALTH ALLIANCE MEDICAL PLANS, INC., ILLINOIS DOMESTIC STOCK INSURANCE CORPORATION, OF PLAINTIFF-APPELLEE,
v.
THE DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES; JULIE HAMOS, IN HER OFFICIAL CAPACITY AS DIRECTOR OF THE DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES;
THE EXECUTIVE ETHICS COMMISSION; MATT BROWN, IN HIS OFFICIAL CAPACITY AS CHIEF PROCUREMENT OFFICER OF THE ILLINOIS EXECUTIVE ETHICS COMMISSION;
THE DEPARTMENT OF CENTRAL MANAGEMENT SERVICES; AND JAMES P. SLEDGE, IN HIS OFFICIAL CAPACITY AS DIRECTOR OF CENTRAL MANAGEMENT SERVICES, DEFENDANTS-APPELLANTS, AND HEALTH CARE SERVICE CORPORATION, AS PARENT COMPANY OF BLUECROSS BLUESHIELD OF ILLINOIS;
BLUECROSS BLUESHIELD OF ILLINOIS BLUE ADVANTAGE; BLUECROSS BLUESHIELD OF ILLINOIS HMO ILLINOIS; PERSONAL CARE INSURANCE OF ILLINOIS, INC.; AND HEALTHLINK HMO, INC., DEFENDANTS, AND
HUMANA HEALTH PLAN, INC.; AND HUMANA INSURANCE COMPANY, DEFENDANTS--APPELLEES. HEALTH ALLIANCE MEDICAL PLANS, INC., PLAINTIFF-APPELLEE,
v.
PERSONAL CARE INSURANCE OF ILLINOIS, INC.; THE DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES;
JULIE HAMOS, IN HER OFFICIAL CAPACITY AS DIRECTOR OF THE DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES;
THE EXECUTIVE ETHICS COMMISSION;
MATT BROWN, IN HIS OFFICIAL CAPACITY AS CHIEF PROCUREMENT OFFICER OF THE ILLINOIS EXECUTIVE ETHICS COMMISSION; THE DEPARTMENT OF CENTRAL MANAGEMENT SERVICES; JAMES P. SLEDGE, IN HIS OFFICIAL CAPACITY AS DIRECTOR OF CENTRAL MANAGEMENT SERVICES; AND HEALTHLINK HMO, INC., DEFENDANTS-APPELLANTS,
AND HEALTH CARE SERVICE CORPORATION, AS PARENT COMPANY OF BLUECROSS BLUESHIELD OF ILLINOIS; BLUECROSS BLUESHIELD OF ILLINOIS BLUE ADVANTAGE; AND BLUECROSS BLUESHIELD OF ILLINOIS HMO ILLINOIS,
DEFENDANTS.



Appeal from an Circuit Court Sangamon County Honorable Brian T. Otwell, Judge Presiding. No. 11MR250

The opinion of the court was delivered by: Justice Steigmann

2011 IL App (4th) 110495

NOS. 4--11--0495, 4--11--0545 cons.

JUSTICE STEIGMANN delivered the judgment of the court, with opinion. Presiding Justice Knecht and Justice Cook concurred in the judgment and opinion.

OPINION

¶ 1 On June 6, 2011, Health Alliance Medical Plans, Inc. (Health Alliance), filed a complaint (1) challenging the decision by the director of the Department of Health and Family Services (DHFS) not to renew its contract to provide Open-Access-Plan (OAP) health insurance to State employees and (2) requesting a stay pending the outcome of its challenge. On June 10, 2011, the circuit court entered an order staying the awards of the OAP contracts "pending the ultimate determination" of this action for administrative review.

¶ 2 DHFS (No. 4--11--0495) and PersonalCare Insurance of Illinois, Inc. (PersonalCare) (No. 4--11--0545) (collectively appellants) appeal, arguing that the circuit court erred by granting Health Alliance's motion for stay pending administrative review. We disagree and affirm.

¶ 3 I. BACKGROUND

¶ 4 A. State Employees Group Insurance Act of 1971

¶ 5 The State Employees Group Insurance Act of 1971 (Insurance Act) (5 ILCS 375/1 through 17 (West 2010)) provides that it is the State's policy to assure "quality benefits" for State employees. See 5 ILCS 375/5 (West 2010). To effectuate that policy, the Insurance Act requires the director of the Department of Central Management (CMS) to contract for--or otherwise make available--health benefits for those employees. 5 ILCS 375/5 (West 2010). (In April 2005, however, the Governor signed an executive order, transferring the responsibilities related to State health-care purchasing under the Insurance Act from the director of CMS to the director of DHFS.) The Insurance Act further provides that with respect to self-insurance, the director must seek the "advice and consent" of the Commission on Government Forecasting and Accountability (COGFA). 5 ILCS 375/6.2 (West 2010). COGFA is a legislative support services agency, the membership of which consists of a bipartisan group of 12 members of the General Assembly appointed by the leadership of the General Assembly as provided by statute (25 ILCS 130/1--5(3) (West 2008), as amended by Public Act 96--959, eff. July 1, 2010). Among its many duties, COGFA is charged with studying and providing the General Assembly with information on economic development and fiscal trends in Illinois and on the operations of State government, recommending State fiscal and economic policies to improve the functioning of State government, and developing a three-year budget forecast for the State, including opportunities and threats concerning anticipated revenues and expenditures (25 ILCS 155/3(1) through (3), (12), (14) (West 2010), as amended by Public Act 96--958, eff. July 1, 2010). COGFA is also charged with overseeing the administration of the State Employees' Group Insurance Program. See 5 ILCS 375/4, 5 (West 2010).

¶ 6 B. The Types of Health Insurance the State Provides

¶ 7 The State provides health insurance benefits in two ways: (1) through managed-care plans, which include (a) HMOs and (b) OAPs, and (2) through preferred provider organizations (PPOs). The State self-insures the OAPs and the PPOs, which means that the State contracts with the OAPs and PPOs to administer the plans but otherwise (1) assumes all the risks and (2) pays the claims made under those plans. In contrast to the OAPs and PPOs, the State fully insures the HMOs, which means that the State pays each HMO a fixed fee, including a risk premium, and the HMO administers the plans and assumes all the risks and pays the claims made under each plan.

¶ 8 C. The Procedural History of This Case

¶ 9 1. The Underlying Contracts

¶ 10 Beginning in September 2010, DHFS issued requests for insurance proposals, seeking proposals from organizations to administer OAPs and/or HMOs beginning July 1, 2011. Health Alliance and Humana Health Plan, Inc. (Humana)--organizations that were administering plans for the State at that time--submitted bids to continue to administer OAPs and HMOs.

¶ 11 In April 2011, DHFS issued a notice of intent to award (1) OAP contracts to HealthLink HMO, Inc. (HealthLink), and PersonalCare Insurance of Illinois, Inc. (PersonalCare), and (2) HMO contracts to organizations owned by BlueCross BlueShield of Illinois (BlueCross). As unsuccessful bidders, Health Alliance and Humana filed protests with the State's chief procurement officer, and the contract awards were stayed pursuant to the administrative code (44 Ill. Adm. Code 1.5550(d) , amended at 30 Ill. Reg. 17305 (eff. Oct. 20, 2006)) until their protests were resolved.

ΒΆ 12 While those protests were pending, COGFA, in response to the changes in health insurance administrators, held a series of hearings on the subject of whether the State should allow self-insurance plans. In conjunction with those hearings, COGFA's co-chairpersons requested an opinion from the Illinois Attorney General regarding the extent of authority granted COGFA under the Insurance Act. Specifically, the co-chairpersons requested the Attorney General's opinion regarding the phrase contained in section 6.2 of the Insurance Act that when the director, "with advice and consent of [COGFA]," determines that it would be in the best interests of the State and its employees, the program of health benefits may be administered with the State as a self-insurer in whole or in part. Shortly thereafter, the Attorney General responded that ...


Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.