UCare Summons and Complaint

7/23/2019 UCare Summons and Complaint

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STATE OF MINNESOTA

ISTRICT COURT

COUNTY OF RAMSEY

ECOND JUDICIAL DISTRICT

Case Type: Other Civil

UCare Minnesota, a Minnesota Non-Profit

Corporation,

Case No.

Plaintiff,

SUMMONS

.

Minnesota Department of Human Services; and

Lucinda E. Jesson, in her capacity as

Commissioner of the Minnesota Department of

Human Services,

Defendants.

THIS SUMMONS IS DIRECTED TO the above-named Defendants.

1

YOU ARE BEING SUED. The Plaintiff has started a lawsuit against you. The

Plaintiff's Complaint against you is attached to this Summons. Do not throw these papers away.

They are official papers that affect your rights. You must respond to this lawsuit even though it

may not yet be filed with the Court and there may be no court file number on this summons.

2.

YOU MUST REPLY WITHIN 20 DAYS TO PROTECT YOUR RIGHTS.

You

must give or mail to the person who signed this summons a written response called an Answer

within 20 days of the date on which you received this Summons. You must send a copy of your

Answer to the person who signed this summons located at:

Greene Espel, PLLP

222 South Ninth Street, Suite 2200

Minneapolis, MN 55402

3.

YOU MUST RESPOND TO EACH CLAIM.

The Answer is your written response

to the Plaintiff's Complaint. In your Answer you must state whether you agree or disagree with

each paragraph of the Complaint. If you believe the Plaintiff should not be given everything

asked for in the Complaint, you must say so in your Answer.

4.

YOU WILL LOSE YOUR CASE IF YOU DO NOT SEND A WRITTEN

RESPONSE TO THE COMPLAINT TO THE PERSON WHO SIGNED THIS

SUMMONS.

If you do not Answer within twenty (20) days, you will lose this case. You will not

get to tell your side of the story, and the Court may decide against you and award the Plaintiff

everything asked for in the Complaint. If you do not want to contest the claims stated in the

Complaint, you do not need to respond. A default judgment can then be entered against you for


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the relief requested in the Complaint.

5.

LEGAL ASSISTANCE.

You may wish to get legal help from a lawyer. If you do not

have a lawyer, the Court Administrator may have information about places where you can get

legal assistance.

Even if you cannot get legal help you must still provide a written Answer to

protect your rights or you m ay lose the case.

6.

ALTERNATIVE DISPUTE RESOLUTION.

The parties may agree to or be

ordered to participate in an alternative dispute resolution process under Rule 114 of the

Minnesota General Rules of Practice. You must still send your written response to the Complaint

even if you expect to use alternative means of resolving this dispute.

Dated: August

I 2015

REENE ESPEL PLLP

D{EspeiReg. No. 27595

John M. Baker, Reg. No. 174403

Monte A. M ills, Reg. No. 030458X

222 S. Ninth Street, Suite 2200


[email protected]

[email protected]

[email protected]

(612) 373-0830

Attorneys for Plaintiff UCare

ACKNOWLEDGMENT

The undersigned hereby acknowledges that costs, disbursements and reasonable attorney

and witness fees may be awarded pursuant to Minn. Stat. 549.211, subdivision 2, to the party

against whom the allegations in this pleading are asserted.

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STATE OF MINNESOTA

ISTRICT COURT

COUNTY OF RAMSEY

ECOND JUD ICIAL DISTRICT

Case Type: Other Civil

UCare M innesota, a M innesota Non -Profit

Corporation,

Case No.

Plaintiff,

v.

COMPLAINT

Minnesota Department of Human Services; and

Lucinda E. Jesson, in her capacity as

Commissioner of the Minnesota Department of

Human Services,

Defendants.

Plaintiff UCare Minnesota ( UCare or Plaintiff'), for its Complaint against Minnesota

Department of Human Services; and Lucinda E. Jesson, in her capacity as Commissioner of the

Minnesota Department of Human Service ( DHS or Defendants ), states and alleges as

follows:

NATURE OF THE ACTION

1

UCare has a 30-year history of providing high-quality, cost-effective health care

coverage and services to low-income individuals and families.

2.

As a result of UCare's proven track record, UCare currently serves more Prepaid

Medical Assistance Program ( PMAP ) and MinnesotaCare members in Minnesota than any

other health plan.

3.

DHS announced on July 28, 2015, that UCare would no longer serve Minnesota's

PM AP and M innesotaCare enrollees, effective January 1, 201 6.


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4.

HS's decision requires 475,000 current public programs members, including

370,000 UCare enrollees, to change their health insurance coverage.

5.

DHS's decision will result in the largest disruption in public health insurance

plans in state history.

6.

DHS's decision arose from a procurement process that violated statutes and

equitable principles of competitive bidding.

PARTIES

7.

UCare is an independent, nonprofit health plan providing health coverage and

services to more than 510,000 members in Minnesota and western Wisconsin. UCare is

headquartered in Minneapolis, Minnesota.

8.

DHS is a department of the State of Minnesota formed and existing under the

laws of the State of Minnesota.

9. Defendant Lucinda E. Jesson is the Commissioner of DHS.

JURISDICTION AND VENUE

10.

This Court has jurisdiction under Minn. Stat. 484.01.

11.

Venue is proper in Ramsey County for this action under Minn. Stat 542.01,

542.03, and 542.09.

FACTS

12.

UCare currently contracts with DHS to offer MinnesotaCare in 71 counties and

PMAP in 62 counties.

13.

At just over 370,000 members, UCare has the largest PMAP and MinnesotaCare

enrollment in Minnesota.

14.

UCare currently serves more people from diverse cultures and more people with

disabilities enrolled in Medical Assistance than any other health plan in Minnesota.

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15.

UCare has invested significant resources and developed innovative programs to

promote health equity for all of its members, but especially members who are persons of color,

new immigrant populations and those with Limited English Proficiency.

16.

UCare has distinguished itself by focusing on the needs of diverse, immigrant

populations and has been recognized nationally and locally as a model for effective delivery of

care to state public program populations.

17.

UCare has been the innovative health plan in developing and providing creative

initiatives to meet the needs of unique communities across Minnesota. UCare was the first plan

to offer free transportation to medical and dental appointments. UCare was the first plan to offer

a mobile dental clinic, which UCare provides in partnership with the University of Minnesota

Dental School.

18.

DHS's recent announcement that, effective January 1, 2016, UCare would no

longer serve Minnesota's PMAP and MinnesotaCare enrollees was the result of a competitive

procurement process that started with a Request for Proposal (RFP) dated January 26, 2015.

19.

The RFP explained that DHS was undertaking a statewide procurement in the 87

counties in Minnesota. The statewide procurement was authorized by the legislature.

20.

The RFP stated that, if a county is in a Metropolitan Statistical Area, for PMAP it

will require at least two managed care organizations (MCOs) be selected to provide health care

services in that county, and the remaining rural counties are not required to have more than a

single MCO.

21.

The RFP stated that for MinnesotaCare a minimum of two MCOs will be

selected in all 87 counties.

22.

In response to the RFP issued by DHS, UCare submitted a proposal to provide

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healthcare services to eligible recipients of PMAP and MinnesotaCare in 2016.

23.

After reviewing the various proposals, at least 47, and reportedly as many as 55,

county boards passed resolutions recommending that DHS contract with UCare to provide

services in their respective counties.

24.

On July 28, 2015, DHS announced the winners of the competitive procurement

process, and that UCare would no longer serve PMAP and MinnesotaCare enrollees, effective

January 1, 2016.

25.

DHS announced the winning MCOs as Blue Plus, HealthPartners, Medica,

PrimeWest, Itasca Medical Care, South C ountry Health Alliance, and Hennepin H ealth.

26.

DHS sent a letter to UCare stating that it selected another Responder(s) to enter

into contract negotiations to meet the State's needs for this statewide procurement.

27.

DHS did not act in a manner consistent with the recommendations of counties

seeking continuation of UCare services.

28.

DHS also announced plans to move up open enrollment from October 1 to

September 1 so U Care members can sw itch plans.

29.

If DHS disallows UCare's service for PMAP and MinnesotaCare enrollees

effective January 1, 2016, it will cause irreparable harm to UCare.

30.

DHS's decision will have significant unintended consequences in the community.

31.

UCare's elimination from the marketplace undercuts the free choice encouraged

by the legislature and removes a demonstrated plan with a history of success serving diverse,

immigrant, and non-English language speaking populations.

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CLAIMS

COUNT I: VIOLATION OF STATE PROCUREMENT LAW

32. Plaintiff realleges paragraphs one (1) through thirty-one (31) as though fully set

forth herein.

33.

DHS's RFP process was arbitrary, capricious, and unreasonable.

34.

DHS's decision to exclude UCare was arbitrary, capricious, and unreasonable.

35. DHS violated statutory mandates for free choice.

36.

DHS lacked proper standards to follow when deciding to draw the line that

determines which RFP responders DHS will refuse to negotiate with.

37.

Ambiguity and uncertainty in the guidelines constituted a violation of the

requirements of competitive bidding.

38. DHS violated equitable principles of competitive procurement.

39. DHS failed to follow the statutory directive to allow county boards to mutually

select the health plans.

40.

DHS's design of the RFP process effectively caused the county boards to

relinquish their statutory role to unelected administrative staff.

41.

DHS violated Minn. Stat. 256B.69.

42. UCare is entitled to recover its costs, expenses, and reasonable attorney fees

incurred in connection with this action.

COUNT II: IMPROPER DISCLOSURE OF CONFIDENTIAL INFORMATION

43.

Plaintiff realleges paragraphs one (1) through forty-two (42) as though fully set

forth herein.

44.

As part of the RFP process, DHS issued a cost data book.

45.

Before DHS released the cost data book, UCare objected to the potential adverse

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competitive impact on UCare resulting from how DHS intends to present cost data in the data

book for the RFP price bidding.

46.

Over UCare's objections, DHS released its cost data book with UCare cost

information available for its com petitors to see.

47.

DHS not only revealed UCare's confidential information, but also potentially

gave other plans a competitive advantage.

48.

DHS created an anti-competitive bidding environment that disproportionately and

negatively impacted UCare in a number of counties where UCare is the only health plan, or

where UCare has the majority of members, because UCare's actual county-specific health care

costs were provided to competitors.

49.

DI-1S's disclosure of UCare's provider payment data violated Minnesota Statutes

section 256B.69, subdivision 9c, which prohibits the release of nonpublic plan data.

COUNT III: UNLAW FUL DESTRUCTION OF DOCUM ENTS

50.

Plaintiff realleges paragraphs one (1) through forty-nine (49) as though fully set

forth herein.

51.

DHS directed counties to destroy documents generated in the procurement

process.

52.

DHS's document-destruction directive included materials that plainly fall within

the scope of the statutory definition of governmental records.

53.

DHS violated Minnesota statutes, including Minnesota's Data Practices Act, by

directing counties to destroy documents related to the competitive procurement process.

COUNT IV: DECLARATORY RELIEF

54.

Plaintiff realleges paragraphs one (1) through fifty-three (53) as though fully set

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forth herein.

55.

n actual controversy exists between UCare and DHS concerning the competitive

procurement process and DHS's decision to exclude UCare from the marketplace.

56. Care is entitled to declaratory judgment from the Court as follows:

a. DHS's competitive procurement process and DHS's decision to exclude UCare

from the marketplace were arbitrary, capricious, and unreasonable.

b. DHS violated equitable principles of competitive procurement;

c.

DHS violated Minn. Stat. 256B.69;

d.

DHS's disclosure of UCare's provider payment data violated Minnesota statutes;

e.

DHS violated Minnesota statutes by directing counties to destroy documents

related to the competitive procurement process;

f. UCare must have the opportunity the opportunity to negotiate with and enter into a

contract with DHS, which will allow UCare to be offered as a choice for PMAP and

MinnesotaCare in 2016 in the counties that recommended UCare.

COUNT V: INJUNCTIVE RELIEF

57. laintiff realleges paragraphs one (1) through fifty-six (56) as though fully set

forth herein.

58. Care will suffer irreparable harm if DHS excludes UCare from the opportunity

to provide health care services to eligible recipients of PMAP and MinnesotaCare.

59.

HS s unlawful conduct has and will continue to irreparably harm UC are.

60. he public interest favors allowing UCare the opportunity to provide health care

services to eligible recipients of PMAP and MinnesotaCare in the counties that recommended

UCare.

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61.

Care is entitled to temporary and permanent injunctive relief:

a.

Ordering DHS not to destroy any documents related to the competitive procurement

process;

b.

Ordering DHS to countermand any instructions given to counties to destroy

documents related to the competitive procurement process;

c.

Ordering DHS to provide UCare documents regarding the procurement process to

the extent permitted by law, including UCare's scores;

d.

Ordering DHS to address questions regarding the extent to which other applicants

have been allowed to modify bids or submissions with additional offers,

negotiations, or otherwise;

e.

Ordering DHS to suspend all managed care enrollment activities for PMAP and

MinnesotaCare for 2016, including the distribution of any materials to beneficiaries

identifying health plan choices for open enrollment, until UCare is allowed to be

offered as a choice for PMAP and MinnesotaCare in counties that recommend

UCare in 2016; and

f.

Ordering DHS to provide UCare the opportunity to negotiate with and enter into a

contract with DHS, which will allow UCare to be offered as a choice for PMAP and

MinnesotaCare in 2016 in the counties that recommended UCare.

WHEREFORE

the Plaintiff prays for judgment in favor of the Plaintiff and against

Defendants, and temporary and permanent injunctive relief:

1

Ordering DHS not to destroy any documents related to the competitive procurement

process;

2.

Ordering DHS to countermand any instructions given to counties to destroy

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documents related to the competitive procurement process;

3.

Ordering DHS to provide UCare documents regarding the procurement process to

the extent permitted by law, including UCare's scores;

4.

Ordering DHS to address questions regarding the extent to which other applicants

have been allowed to modify bids or submissions with additional offers, negotiations, or otherwise;

5. Ordering DHS to suspend all managed care enrollment activities for PMAP and

MinnesotaCare for 2016, including the distribution of any materials to beneficiaries identifying

health plan choices for open enrollment, until UCare is allowed to be offered as a choice for PMAP

and MinnesotaCare in counties that recommend UCare in 2016;

6.

Ordering DHS to provide UCare the opportunity to negotiate with and enter into a

contract with DHS, which will allow UCare to be offered as a choice for PMAP and MinnesotaCare

in 2016 in the counties that recommended UCare;

7.

Ordering that UCare is entitled to an award of its attorney fees, costs, and

disbursements incurred in this action; and

8.

For such other and further relief as the Court deems just and equitable.

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Dated: August

/ / , 2015

REENE ESPEL PLLP

Larry. Espe, Reg. No. 27595

John M. Baker, Reg. No. 174403

Monte A. M ills, Reg. No. 030458X

222 S. Ninth Street, Suite 2200


[email protected]

[email protected]

[email protected]

(612) 373-0830

Attorneys for Plaintiff UCare

ACKNOWLEDGMENT

The undersigned hereby acknowledges that costs, disbursements and reasonable attorney

and witness fees may be awarded pursuant to Minn. Stat. 549.211, subdivision 2, to the party

against whom the allegations in this pleading are asserted.

Documents

UCare Summons and Complaint