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Wilson v. Cmty. Health Choice Tex., Inc.

TEXAS COURT OF APPEALS, THIRD DISTRICT, AT AUSTIN
Aug 14, 2020
607 S.W.3d 843 (Tex. App. 2020)

Opinion

NO. 03-20-00153-CV

08-14-2020

Phil WILSON, in His Official Capacity as Acting Executive Commissioner of Texas Health & Human Services Commission, Appellant v. COMMUNITY HEALTH CHOICE TEXAS, INC., Appellee

Clark Richards, Daniel R. Richards, Austin, for Community First Health Plans, Inc. Nancy S. Elmilady, Houston, Joshua Eames-Cepero, for Appellant. Carlos R. Soltero, Kurt H. Kuhn, Austin, for Appellee.


Clark Richards, Daniel R. Richards, Austin, for Community First Health Plans, Inc.

Nancy S. Elmilady, Houston, Joshua Eames-Cepero, for Appellant.

Carlos R. Soltero, Kurt H. Kuhn, Austin, for Appellee.

Before Chief Justice Rose, Justices Baker and Triana

OPINION

Gisela D. Triana, Justice

Phil Wilson, in his official capacity as the acting executive commissioner of the Texas Health and Human Services Commission (HHSC), appeals the denial of pleas to the jurisdiction. See Tex. Civ. Prac. & Rem. Code § 51.014(a)(8). For the reasons that follow, we affirm the district court's decision on the pleas to the jurisdiction.

HHSC's executive commissioner is the agency's chief executive officer. See Tex. Health & Safety Code § 11.012(e).

BACKGROUND

Medicaid is a cooperative federal-state health benefit program for certain low-income and disabled individuals. See generally 42 U.S.C. §§ 1396 - 1396w (Grants to States for Medical Assistance Programs). Although federal law establishes Medicaid's basic parameters, each state decides the nature and scope of its Medicaid program. See id. § 1396a(a), (b); 42 C.F.R. § 430.10. In Texas, HHSC is the agency designated to administer Medicaid. See Tex. Hum. Res. Code § 32.021(a) ; Tex. Gov't Code § 531.021(a). One vehicle through which the State delivers services to Medicaid recipients is the State of Texas Access Reform (STAR)+PLUS managed care program. Certain Texas Medicaid recipients must enroll in STAR+PLUS, which provides services for recipients with disabilities or who are age 65 or older. See 1 Tex. Admin. Code § 353.603 (Tex. Health & Human Servs. Comm'n, Member Participation). HHSC contracts with managed care organizations (MCOs) to provide services to STAR+PLUS enrollees. See id. §§ 353.407 (Requirements of Managed Care Plans), .601(c) (General Provisions). MCOs are health maintenance organizations, dental indemnity insurance providers, or dental health maintenance organizations licensed or approved by the Texas Department of Insurance. Id. § 353.2(26), (50), (61) (Definitions).

When purchasing or contracting for goods and services, state agencies, including HHSC, must comply with statutory requirements such as those found in chapter 2155 of the Government Code, which addresses "General Rules and Procedures" for purchasing. See Tex. Gov't Code §§ 2155.144 ("Procurements by Health and Human Services Agencies"), .074 ("Best Value Standard for Purchase of Goods or Services"), .075 ("Requirement to Specify Value Factors in Request for Bids or Proposals"); see also id. §§ 2151.001-2176.202 ("State Purchasing and General Services"). In addition to adhering to those general requirements, HHSC must implement the Medicaid managed care program by contracting with MCOs in a manner consistent with chapter 533 of the Government Code, see Tex. Gov't Code §§ 533.001 -.084 ("Medicaid Managed Care Program"), including section 533.004, which addresses "Mandatory Contracts" and specifies, as relevant here:

(a) In providing health care services through Medicaid managed care to recipients in a health care service region, the commission shall contract with a managed care organization in that region that is licensed under Chapter 843, Insurance Code, to provide health care in that region and that is:

(1) wholly owned and operated by a hospital district in that region;

(2) created by a nonprofit corporation that:

(A) has a contract, agreement, or other arrangement with a hospital district in that region or with a municipality in that region that owns a hospital licensed under Chapter 241, Health and Safety Code, and has an obligation to provide health care to indigent patients; and

(B) under the contract, agreement, or other arrangement, assumes the obligation to provide health care to indigent patients and leases, manages, or operates a hospital facility owned by the hospital district or municipality; or

(3) created by a nonprofit corporation that has a contract, agreement, or other arrangement with a hospital district in that region under which the nonprofit corporation acts as an agent of the district and assumes the district's obligation to arrange for services under the Medicaid expansion for children as authorized by Chapter 444, Acts of the 74th Legislature, Regular Session, 1995.

(b) A managed care organization described by Subsection (a) is subject to all terms and conditions to which other managed care organizations are subject, including all contractual, regulatory, and statutory provisions relating to participation in the Medicaid managed care program.

Appellee Community Health Choice Texas, Inc., is without question an MCO described by section 533.004(a). Community Health is a nonprofit MCO wholly owned and operated by the Harris County Hospital District. The commissioner does not dispute that Community Health is the only hospital-owned and -operated MCO in its service area, which encompasses the greater Houston area east to the Louisiana border, including the Harris and Jefferson service areas. In early 2018, HHSC issued a Request for Proposal (RFP) to procure services for STAR+PLUS enrollees in several service areas, including the Harris and Jefferson service areas. In response, Community Health submitted a bid to provide service in those two areas. HHSC withdrew that first RFP, then issued a second one, for which Community Health also submitted a bid. Once again, HHSC withdrew the RFP. In October 2018, HHSC issued a third RFP. Community Health was the only entity described by section 533.004(a) that responded to that request for proposal with a bid for services. The RFP stated that "HHSC intends to award contracts to at least two MCOs for each SA [service area] to provide Covered services required of this RFP to STAR+PLUS eligible Members in these SAs." It also provided for an "anticipated" effective date of June 28, 2019, with an operational start date of June 1, 2020. The RFP expressly allowed HHSC to modify these dates at any time upon posting notice to the Electronic State Business Daily. In October 2019, HHSC announced its intention to award three contracts in the Harris service area and two contracts in the Jefferson service area. These five contracts were to be awarded to out-of-state, for-profit companies. Community Health asserts that until this STAR+PLUS procurement, HHSC had consistently followed section 533.004's requirement to award at least one contract to a nonprofit or hospital-district-owned entity in the particular service area.

In November 2019, in response to the commissioner's decision to award contracts without awarding them any to an entity described by section 533.004, Community Health sued the commissioner, asserting an ultra vires claim and seeking "injunctive, mandamus, and declaratory relief." Community Health specifically sought a declaration that the commissioner "failed to comply with the Texas Government Code," an injunction prohibiting the commissioner from violating section 533.004 by contracting solely with for-profit entities, and an order that the commissioner sign a contract with Community Health as the only entity that satisfies the criteria of section 533.004 for the Harris and Jefferson service areas. The commissioner answered with a general denial and alleged sovereign immunity as an affirmative defense. Community Health moved for summary judgment on its claim based on the undisputed facts. On December 5, 2019, the commissioner filed a plea to the jurisdiction asserting he was protected from suit by sovereign immunity. The following week, the commissioner filed a "supplemental plea to the jurisdiction" asserting that Community Health's claims, which sought to prevent the commissioner from awarding the contracts in violation of section 533.004, had become moot because the commissioner had, as of December 9 and 10, executed and officially awarded the contracts to the for-profit entities as planned. After conducting a hearing on both the summary judgment motion and the pleas to the jurisdiction, the district court granted Community Health's summary judgment and denied the pleas to the jurisdiction in an order signed February 7, 2020. The commissioner filed a notice of appeal. On March 24, Community Health filed an emergency motion in this Court seeking to require the commissioner to comply with the district court's February 7 order while this appeal was pending so that Community Health would not be excluded from preparing to participate in the STAR+PLUS Program. The RFP had indicated that entities selected to provide STAR+PLUS services are required to participate in preparatory work before they begin providing services. The day after Community Health's emergency motion was filed, HHSC cancelled "all contracts associated with" the third RFP because "it is in the best interest of the State of Texas," and this Court determined that the motion was therefore moot. On appeal, the commissioner asserts that (1) HHSC's cancellation of the contracts moots this cause such that this Court should vacate the district court's order and dismiss the entire case as moot; and (2) if this cause is not moot, the district court lacks subject matter jurisdiction over Community Health's claims because there is no justiciable controversy between the parties, section 533.004(a) does not impose a ministerial duty on the commissioner and so Community Health has not pled an ultra vires claim against the commissioner, and Community Health seeks impermissible retrospective relief.

The parties do not seek review of the summary judgment, and we limit our review to the trial court's denial of HHSC's plea to the jurisdiction. See Tex. Civ. Prac. & Rem. Code § 51.014(a)(8) (authorizing interlocutory appeal from order granting or denying governmental unit's plea to the jurisdiction); Dallas Symphony Ass'n, Inc. v. Reyes , 571 S.W.3d 753, 761 (Tex. 2019) (noting "courts have construed Section 51.014(a)(8), which provides for an appeal of an interlocutory order granting or denying ‘a plea to the jurisdiction by a governmental unit’ as allowing review of only the portion of an order addressing the plea to the jurisdiction" although expressly noting that "we do not approve or disapprove the holdings in these cases" (collecting cases)); Nazari v. State , 497 S.W.3d 169 (Tex. App.—Austin 2016), aff'd 561 S.W.3d 495 (Tex. 2018) ("When a party appeals from two interlocutory rulings, ‘only one of which is made appealable by statute, the proper course is to dismiss that portion which is non-appealable, and to rule on the portion from which an appeal may be taken.’ ") (quoting Bobbitt v. Cantu , 992 S.W.2d 709, 712 (Tex. App.—Austin 1999, no pet.) ); Bobbitt , 992 S.W.2d at 713 (determining that a grant of partial summary judgment is not appealable even though the grant was in same order that granted relief that could be subject of interlocutory appeal).

ANALYSIS

Mootness and Justiciability

The commissioner first asserts that his cancellation of the contracts has mooted this cause. He similarly urges as part of his second issue that the district court lacks subject matter jurisdiction because cancellation of the contracts extinguished any live controversy that might have existed. In both of these arguments, the commissioner asserts that there is no remaining live controversy, and thus no justiciable interest between the parties, because the relief sought was specific to the contracts resulting from the third RFP. Overall, the commissioner's justiciability argument repeats his argument regarding mootness (which is the result when a justiciable controversy ceases to exist), so we address these issues together. See Texas Quarter Horse Ass'n v. American Legion Dep't , 496 S.W.3d 175, 180-82 (Tex. App.—Austin 2016, no pet.) (discussing justiciability doctrines including mootness).

We review the question of mootness de novo. Matthews v. Kountze Indep. Sch. Dist. , 484 S.W.3d 416, 418 (Tex. 2016) (citing Heckman v. Williamson Cty. , 369 S.W.3d 137, 149-50 (Tex. 2012) ). "The mootness doctrine applies to cases in which a justiciable controversy exists between the parties at the time the case arose, but the live controversy ceases because of subsequent events." Id. The doctrine prevents courts from rendering advisory opinions. Id. (citing Valley Baptist Med. Ctr. v. Gonzalez , 33 S.W.3d 821, 822 (Tex. 2000) (per curiam)). "A defendant's cessation of challenged conduct does not, in itself, deprive a court of the power to hear or determine claims for prospective relief." Id. Otherwise, "defendants could control the jurisdiction of courts with protestations of repentance and reform, while remaining free to return to their old ways," which "would obviously defeat the public interest in having the legality of the challenged conduct settled." Id. However, dismissal may be appropriate when subsequent events make "absolutely clear" that the challenged conduct could not reasonably be expected to recur. Id. (quoting Bexar Metro. Water Dist. v. City of Bulverde , 234 S.W.3d 126, 131 (Tex. App.—Austin 2007, no. pet.) ). "Persuading a court that the challenged conduct cannot reasonably be expected to recur is a ‘heavy burden.’ " Id. (quoting County of Los Angeles v. Davis , 440 U.S. 625, 631, 99 S.Ct. 1379, 59 L.Ed.2d 642 (1979) ).

In this case, the commissioner voluntarily took actions that purportedly moot Community Health's justiciable interest. The commissioner asserts that Community Health's claims relate only to the contracts resulting from the third RFP and argues that because he cannot now "easily undo" the cancellation of the contracts with the for-profit MCOs, he has satisfied the "heavy burden" of showing that his conduct cannot reasonably be expected to recur. In support of his position, he cites Texas State Board of Veterinary Medical Examiners v. Jefferson , in which this Court held that a cross-appeal by a veterinarian was moot where the Board, whose disciplinary enforcement actions were challenged, retreated from its challenged position by seeking dismissal with prejudice of its pending claims against the veterinarian after an administrative law judge (ALJ) had expressly found in favor of the veterinarian on the challenged issue. See No. 03-14-00774-CV, 2016 Tex. App. LEXIS 2002 at *18 (Tex. App.—Austin Feb. 26, 2016, no pet.) (mem. op.). The Court explained, "This finding is binding on the Board in any subsequent proceeding against [the veterinarian arising from similar circumstances]," such that the Board was precluded from instituting similar enforcement proceedings against the veterinarian. Id. at *18-19. Because the relief the veterinarian sought was "coextensive" with the ALJ's finding, and because the Board represented to this Court that its dismissal and the ALJ finding would prevent it from instituting further disciplinary proceedings arising out of the same conduct, the cross-appeal was moot. Id. at *19.

The circumstances of this case differ from those in Jefferson . Regardless of whether the specific canceled contracts could be reinstated or not, Community Health's complaint is that the commissioner's act of awarding any STAR+PLUS contracts without awarding at least one contract per service area to an entity described by section 533.004(a) is an ultra vires act. The commissioner has not demonstrated that there is no reasonable expectation that HHSC will not issue a fourth RFP for STAR+PLUS services in the Harris and Jefferson service areas and again choose not to award a contract in each service area to an MCO qualified under section 533.004(a). Cf. Kountze , 484 S.W.3d at 420 (stating school district's cessation of conduct "provides no assurance that the District will not prohibit the cheerleaders from displaying banners with religious signs or messages at school-sponsored events in the future"); Texas Health Care Info. Council v. Seton Health Plan, Inc. , 94 S.W.3d 841, 848 (Tex. App.—Austin 2002, pet. denied) (noting that although the state defendant ceased conduct, the case was not moot because "the threat remained that the [defendant] could reinstate its policy of assessing an excessive penalty based on an erroneous construction of the statute"). As the commissioner explains in his brief, "The Commissioner has already announced that it is re-procuring the contracts that Community Health applied for," and notes that Community Health "may or may not" apply for and be awarded the contract. In this case, the commissioner's narrow reading of what constitutes the challenged conduct and his insistence that by canceling the contract he has rendered the dispute "theoretical" run afoul of the Texas Supreme Court's directive in Kountze that a defendant should not be able to "control the jurisdiction of courts" through cessation of conduct "while remaining free to return to their old ways." 484 S.W.3d at 418. The commissioner has said he will re-procure the contracts and he has consistently maintained in the district court and in briefing before this Court that he may award contracts to entities that do not qualify under section 533.004(a) without awarding a contract to Community Health, even where Community Health is the sole entity that meets the criteria of section 533.004. We conclude that the commissioner's cancellation of the contracts has not resulted in the lack of a justiciable controversy and the cause is not moot. We overrule the commissioner's mootness and justiciability issues.

Plea to the Jurisdiction

A plea to the jurisdiction challenges a trial court's authority to decide the subject matter of a specific cause of action. See Texas Dep't of Parks & Wildlife v. Miranda , 133 S.W.3d 217, 225-26 (Tex. 2004). Analysis of whether this authority exists begins with the plaintiff's live pleadings. Id. at 226. The plaintiff has the initial burden of alleging facts that affirmatively demonstrate the trial court's jurisdiction to hear the cause. Id. (citing Texas Ass'n of Bus. v. Texas Air Control Bd. , 852 S.W.2d 440, 446 (Tex. 1993) ). Mere unsupported legal conclusions do not suffice. See Creedmoor-Maha Water Supply Corp. v. Texas Comm'n on Envtl. Quality , 307 S.W.3d 505, 515-16 & nn.7-8 (Tex. App.—Austin 2010, no pet.). "When a plea to the jurisdiction challenges the pleadings, we determine whether the plaintiff has alleged sufficient jurisdictional facts to show the trial court's subject-matter jurisdiction, using a liberal construction in favor of the plaintiff." First-Citizens Bank & Tr. Co. v. Greater Austin Area Telecomms. Network , 318 S.W.3d 560, 564 (Tex. App.—Austin 2010, no pet.) (citing Miranda , 133 S.W.3d at 226 ). Whether a court has subject-matter jurisdiction is a question of law, which we review de novo. Id.

Sovereign immunity extends to state officials acting in their official capacity. See City of El Paso v. Heinrich , 284 S.W.3d 366, 369-70 (Tex. 2009). Under the ultra-vires exception to sovereign immunity, however, a plaintiff may sue a state officer, in his or her official capacity, to obtain prospective declaratory or injunctive relief restraining conduct that is beyond statutory or constitutional authority. See id. at 372-73. To fall within this exception to immunity, "a suit must not complain of a government officer's exercise of discretion, but rather must allege, and ultimately prove, that the officer acted without legal authority or failed to perform a purely ministerial act." Id. at 372. An officer acts without legal authority if he "exceeds the bounds of his granted authority or if his acts conflict with the law itself." Houston Belt & Terminal Ry. Co. v. City of Houston , 487 S.W.3d 154, 158 (Tex. 2016). If the plaintiff alleges, or ultimately can prove acts only within the officer's legal authority and discretion, the claim seeks "to control state action" and is barred by sovereign immunity. Id. ; KEM Tex., Ltd. v. Texas Dep't of Transp. , No. 03-08-00468, 2009 WL 1811102, at *2 (Tex. App.—Austin June 26, 2009, no pet.) (mem. op.).

In its live pleadings, Community Health sought declaratory and injunctive relief on the premise that, because HHSC decided to award contracts in the Harris and Jefferson service areas, the commissioner was without discretion under section 533.004 not to award Community Health a STAR+PLUS contract for which it had applied in those areas. Community Health has thus pleaded a cognizable ultra vires claim if it can establish that the commissioner's decision not to award it a contract exceeded the bounds of his authority or conflicts with the law itself. See Houston Belt & Terminal Ry. , 487 S.W.3d at 158. To determine whether Community Health has invoked the district court's jurisdiction by pleading a valid ultra vires claim, we must determine whether the commissioner has discretion to decide whether to award the contracts solely to entities not described by section 533.004(a) in light of the statutes governing HHSC's procurements of Medicaid managed care services. See Heinrich , 284 S.W.3d at 372-73 ; Texas Dep't of Transp. v. Sunset Transp., Inc. , 357 S.W.3d 691, 701 (Tex. App.—Austin 2011, no pet.) (construing statutory provisions to determine the scope of state agency's legal authority as applied to the facts alleged).

Determining whether the commissioner has discretion to award contracts without awarding a contract in a particular service area to the sole applicant meeting the requirements of section 533.004(a) requires us to construe the statutes that apply to HHSC's STAR+PLUS procurements. Statutory construction is a question of law that we review de novo. First Am. Title Ins. v. Combs , 258 S.W.3d 627, 632 (Tex. 2008) ; State v. Shumake , 199 S.W.3d 279, 284 (Tex. 2006). Our primary objective in statutory construction is to give effect to the Legislature's intent. Shumake , 199 S.W.3d at 284. We seek that intent "first and foremost" in the statutory text. Lexington Ins. v. Strayhorn , 209 S.W.3d 83, 85 (Tex. 2006). "Where text is clear, text is determinative of that intent." Entergy Gulf States, Inc. v. Summers , 282 S.W.3d 433, 437 (Tex. 2009) (op. on reh'g) (citing Shumake , 199 S.W.3d at 284 ; Alex Sheshunoff Mgmt. Servs. v. Johnson , 209 S.W.3d 644, 651-52 (Tex. 2006) ). In other words, we give such statutes their plain meaning unless a different meaning is apparent from the context or the plain meaning leads to absurd results. In re Ford Motor Co. , 442 S.W.3d 265, 280 (Tex. 2014) (orig. proceeding). In determining a statute's meaning, we construe the statute as a whole rather than construing specific provisions in isolation. Id. We look at the entire act in determining the legislature's intent with respect to specific provisions. Railroad Comm'n v. Texas Citizens for a Safe Future & Clean Water , 336 S.W.3d 619, 628 (Tex. 2011). Undefined terms are afforded their ordinary meaning unless a different or more precise definition is apparent from the context of the statute, see Tex. Gov't Code § 311.011(a) ; TGS-NOPEC Geophysical Co. v. Combs , 340 S.W.3d 432, 439 (Tex. 2011), because we cannot give an undefined term a meaning that is disharmonious or inconsistent with other provisions in the statute, see Texas Dep't of Transp. v. Needham , 82 S.W.3d 314, 318 (Tex. 2002).

Although the parties agree that Community Health is an entity described by section 533.004(a), they dispute whether that statute requires the commissioner to award a contract to such an entity when HHSC seeks to provide health care services through Medicaid managed care. Section 533.004(a) states that "[i]n providing health care services through Medicaid managed care," HHSC "shall contract" with a licensed entity "wholly owned and operated by a hospital district in that region" and "created by a nonprofit corporation." Tex. Gov't Code § 533.004(a). The commissioner asserts that notwithstanding subsection (a), he has authority to award contracts without awarding a contract to any entity described by subsection (a) based on subsection (b)'s statement that an MCO described by subsection (a) "is subject to all terms and conditions to which other managed care organizations are subject, including all ... statutory provisions relating to participation in the Medicaid managed care program." Id. § 533.004(b). He contends that subsection (b)'s language means that the selection of MCOs under section 533.004 is subject to the MCO also providing "the best value for the state" under the State Purchasing and General Services Statute. See id. §§ 2155.074 ("For a purchase of goods and services under this chapter, each state agency, including the comptroller, shall purchase goods and services that provide the best value for the state."), .144 ("An agency to which this section applies shall acquire goods or services by any procurement method approved by the Health and Human Services Commission that provides the best value to the agency."). In support of this position, he cites section 2155.144(n), which provides, "To the extent of any conflict, this section prevails over any other state law relating to the procurement of goods and services," to argue that the legislature intended best value requirements to apply and to control which MCOs are awarded contract regardless of whether the MCOs have status under section 533.004(a). See id. § 2155.144(n). He further asserts that determining the "best value" to the state is a matter entrusted to his discretion. The commissioner concludes that because the best value standard applies, he could award the contracts to any entities that provided the best value and did not have a ministerial duty to award a contract to Community Health under section 533.004(a). Instead, he urges that he "had discretion to determine whether Community Health also complied with Subsection 533.004(b)" by providing the best value to the state. The commissioner contends that if he lacks the discretion to award contracts in a particular service area without awarding a contract to an entity described in section 533.004(a), then he would be forced to award contracts under 533.004(a) to MCOs "even if they fail to meet all the requirements that all other MCOs are subject to, notwithstanding the language of Subsection 533.004(b)." As a result, the commissioner argues, rejecting his interpretation of the statute renders section 533.004(b) a nullity in that MCOs with status under section 533.004(a) would not be subject to any procurement requirements, including the best value requirements of chapter 2155. He urges that such a construction would result in HHSC being forced to contract with an MCO that "is unable to provide critical services to the vulnerable patients under the STAR+PLUS program." But see id. § 533.005 (specifying required contract provisions). The commissioner notes that Community Health scored the lowest of any respondent and concludes that it therefore "could not provide best value under the best value factors," which were set out by HHSC's RFP.

Community Health addressed the issue of its ranking by asserting that the commissioner's argument ignores "the fact that Community Health has a long history of providing highly-rated—by [HHSC] itself—managed care services in STAR programs, consistently tying or outperforming all other managed care organizations in both the Harris and Jefferson service areas" and that Community Health's score was within seven points of the top score, meaning that it was qualified to provide STAR+PLUS services. Therefore, this is not a situation in which the state would have been forced to contract with an entity unable to provide critical STAR+PLUS services. Community Health also urges a different construction of section 533.004, disagreeing that chapter 2155 provides the commissioner "discretion to award contracts to whoever he subjectively determines offers the ‘best value’ " without regard for the language of section 533.004(a). Community Health points to the legislative history of these statutes to argue that the commissioner's position is "unsupportable." Community Health contends that the commissioner's construction of section 533.004 would render subsection (a) a nullity by allowing the more general best value requirements for purchasing and HHSC procurements to trump the specific "Mandatory Contracts" requirement of section 533.004(a). See Tex. Gov't Code § 311.026(b) ("If the conflict between the general provision and the special or local provision is irreconcilable, the special or local provision prevails as an exception to the general provision...."). Treating the best value requirements as controlling also raises a question as to the meaning and function of section 533.003, which lists factors other than best value that HHSC must consider in awarding contracts to MCOs. See id. § 533.003. To avoid rendering the language of section 533.004(a) meaningless, Community Health reads it to require the commissioner to heed the express language stating that, in contracting with entities to provide Medicaid managed care services, HHSC "shall contract with a [licensed] managed care organization" described by that section.

We cannot conclude that section 533.004 expresses the legislature's intent that subsection (b) incorporate a best value requirement that would entitle the commissioner to disregard the language of subsection (a). We "presume that the Legislature chose its words with care and used every phrase with a purpose, and where possible we give effect to every word and phrase so no part of a statute will be rendered meaningless." Sunstate Equip. Co. v. Hegar , 601 S.W.3d 685, 694 (Tex. 2020) (citing Tex. Gov't Code § 311.021(2) ). Construing section 533.004(a) to require the commissioner to award a contract to a qualifying MCO is consistent with section 533.004(b), which operates to apply the requirements relating to participation in the Medicaid managed care program to nonprofit MCOs and those owned and operated by a hospital district. E.g. , Tex. Gov't Code §§ 533.0031 (requiring accreditation of a managed care plan offered by a Medicaid MCO and allowing information shared with an accreditation organization to be used in HHSC's oversight process), .004(c) (requiring "the awarding and renewal of a mandatory contract" contingent on the hospital district's entering into a funds-matching agreement to expand Medicaid to children and requiring the funds-matching agreement to be a condition of continuing the contract). Indeed, subsection (b) required Community Health to comply with the terms and conditions of the more than two-hundred-page RFP in order to be considered for the contract. Under the circumstances, we disagree that construing section 533.004(a) as requiring that the commissioner contract with a qualifying MCO would render subsection (b) meaningless. Nor is this construction inconsistent with adhering to the generally applicable best value requirements, which would apply when choosing among MCOs in districts where multiple MCOs qualify under section 533.004(a) and would apply to the commissioner's evaluation of for-profit entities. We determine that under the statute's plain language and taking into account, as we must, the whole statutory scheme, once the commissioner decided to award contracts, he was required to contract with an entity described in section 533.004(a). See In re Ford Motor Co. , 442 S.W.3d at 280. Accordingly, we conclude that by alleging the commissioner refused to do so, Community Health has alleged an ultra vires act.

The commissioner asserts that sovereign immunity nonetheless bars Community Health's claims because Community Health seeks retrospective relief. Sovereign immunity bars retrospective relief. Heinrich , 284 S.W.3d at 376 ; Texas Educ. Agency v. American YouthWorks, Inc. , 496 S.W.3d 244, 256 (Tex. App.—Austin 2016), aff'd sub nom. Honors Acad., Inc. v. Texas Educ. Agency , 555 S.W.3d 54 (Tex. 2018). The commissioner construes Community Health's pleadings as applying solely to the third RFP. We agree with the commissioner that to the extent Community Health sought to be awarded a contract as a result of the now nonexistent third RFP, such relief is retrospective and would be barred. However, to the extent that Community Health seeks to enjoin the commissioner from disregarding section 533.004(a)'s requirement or seeks a declaration that he must comply with that statute, Community Health is seeking prospective, not retrospective relief. In its live pleading, "Community Health seeks injunctive relief" to "restrain [the commissioner] from the continued violations of the law." It also seeks a declaration that the commissioner "has failed to comply" with section 533.004(a). Liberally construing these pleadings in favor of Community Health, as we must, these requests seek prospective relief. See First-Citizens , 318 S.W.3d 560 at 564. Having determined that Community Health alleged an ultra vires claim and seeks prospective relief, we determine that the district court did not err in denying the commissioner's plea to the jurisdiction.

Conclusion

For the foregoing reasons, we affirm the district court's denial of the pleas to the jurisdiction. We expressly do not comment on the district court's order as it relates to the summary judgment ruling that is not before us. We remand this cause to the district court for further proceedings consistent with this opinion.


Summaries of

Wilson v. Cmty. Health Choice Tex., Inc.

TEXAS COURT OF APPEALS, THIRD DISTRICT, AT AUSTIN
Aug 14, 2020
607 S.W.3d 843 (Tex. App. 2020)
Case details for

Wilson v. Cmty. Health Choice Tex., Inc.

Case Details

Full title:Phil Wilson, in His Official Capacity as Acting Executive Commissioner of…

Court:TEXAS COURT OF APPEALS, THIRD DISTRICT, AT AUSTIN

Date published: Aug 14, 2020

Citations

607 S.W.3d 843 (Tex. App. 2020)

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