On March 25, 2019, the Hospital and Healthsystem Association of Pennsylvania (HAP), Pennsylvania’s largest hospital association, filed a motion in the Middle District of Pennsylvania to intervene in University Pittsburgh Medical Center (UPMC)’s dispute with Highmark Health (Highmark), which is the Blue Cross/Blue Shield Association’s licensee in Western Pennsylvania.

This dispute commenced in 2012 when UPMC announced that it would no longer continue to contract with Highmark following Highmark’s proposed affiliation with Allegheny Health Network. After two years of negotiations, the parties reached a consent decree in 2014 which provided in-network access for Highmark members to UPMC providers. An unsigned copy of the consent decree is available here. The Consent Decree between UPMC and Highmark is scheduled to expire on June 30, 2019. Upon expiration of the Consent Decree, it is estimated that 175,000 Pennsylvania Highmark Medicare Advantage plan members will lose in-network access to 11 UPMC hospitals and most UPMC physicians.

In an effort to compel the parties to further extend the terms of the Consent Decree or otherwise settle the dispute, on February 7, 2019, Attorney General Josh Shapiro sued UPMC “request[ing] that the Court impose modifications to protect and promote the public interest by ensuring that UPMC abides by its charitable obligations to the Commonwealth of Pennsylvania.”  In this lawsuit, Attorney General Shapiro claims UPMC violated state law by restricting access to its network of hospitals and physicians.

Soon after, in late February 2019, UPMC counter-sued the Pennsylvania Attorney General’s office over its attempt to compel UPMC to work with Highmark to mitigate the consequences of the expiration of the soon expiring Consent Decree. UPMC is seeking a preliminary injunction to stop Attorney General Shapiro from interfering in negotiations or any future agreement between UPMC and Highmark.

HAP has now motioned the court for permission to intervene in the lawsuit in support of UPMC. In a statement published to its website, HAP argues that Attorney General Shapiro’s plan would “potentially force all nonprofit hospitals to do business with any insurer regardless of that insurer’s offered payment terms, procedures for assuring high-quality care, or the strength of its provider network.”