Managed Care Organizations’ Rates Shielded From Disclosure

Stradley Ronon secured a victory for several health plan clients when the Pennsylvania Commonwealth Court ruled that Pennsylvania law does not require that rates paid to nursing homes by insurers participating in the Pennsylvania Medical Assistance program, also known as HealthChoices, must be publicly disclosed in response to a records request for those rates under the Right-to-Know Law. Following a petitioner’s Right-to-Know Law request for the rates, Stradley, representing a number of health plan clients, including UnitedHealthcare, Aetna, Independence Blue Cross, UPMC and Geisinger, intervened in the matter and sought to shield the rates from disclosure because they are proprietary and confidential. After an adverse ruling by the Office of Open Records, the firm appealed to the Commonwealth Court, which ruled in favor of the health plan clients – unanimously in one opinion, and 6 to 1 in the other – on virtually every issue, and remanded to the OOR for reconsideration of two issues.

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