Mississippi State & School Employees' Life & Health Plan v. KCC, Inc.
108 So. 3d 932
Miss.2013Background
- Vital Care filed suit in 2010 alleging the Plan and Catalyst violated MS code 83-9-6 by designating Walgreens as sole specialty-pharmacy provider.
- Vital Care claimed it has provided specialty pharmacy services in Mississippi since 1997 and participates under the Plan since 2006 under terms of reimbursement.
- In Oct. 2009 the Plan and Catalyst closed the Plan's specialty-pharmacy network and made Walgreens the sole approved provider, reportedly after a Walgreens payment related to forming an entity for specialty services.
- Vital Care sought injunctive relief and declaratory relief that 83-9-6 applies to the Plan and that exclusion of Vital Care violates the statute.
- The chancery court granted partial summary judgment concluding 83-9-6 applies to the Plan; the Plan and Catalyst appealed.
- The Supreme Court held that 83-9-6 applies to the Plan as it covers all health benefit plans and is not ambiguous, affirming the partial summary judgment.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Does 83-9-6 apply to the Plan? | Vital Care: statute applies to all health benefit plans. | Plan: ambiguity due to conflicting statutes; may not apply to Plan. | Yes; statute applies to the Plan. |
| Does 83-9-6 apply to Catalyst as the Plan’s administrator? | If 83-9-6 applies to the Plan, Catalyst is treated as its agent and subject to the same restriction. | Catalyst is not a health benefit plan; the issue is not reached if the Plan is the target. | Issue not reached; no error found in applying to the Plan; no ruling on Catalyst. |
| Is the Board's and agency interpretations of 25-15-303(3) entitled to deference when 83-9-6 is unambiguous? | Board’s interpretation should be considered; it says 83-9-6 doesn’t apply to Plan. | Court should defer to agency only when interpretation is reasonable and statutory language is ambiguous. | No deference due because 83-9-6 is not ambiguous; Board’s interpretation rejected. |
Key Cases Cited
- Mississippi Ethics Comm’n v. Grisham, 957 So.2d 997 (Miss. 2007) (plain meaning controls when language is unambiguous)
- Marx v. Broom, 632 So.2d 1315 (Miss. 1994) (statutory interpretation when considering purpose and text)
- Williams v. Farmer, 876 So.2d 300 (Miss. 2004) (consideration of related statutes in pari materia)
- Diamond Grove Center, LLC v. Miss. State Dep’t of Health, 98 So.3d 1068 (Miss. 2012) (deference framework for agency interpretations)
- Miss. Methodist Hosp. v. Miss. State Dep’t of Health, 21 So.3d 603 (Miss. 2011) (agency interpretation of governing statutes; limits of deference)