{"id":22971,"date":"2021-11-19T20:24:27","date_gmt":"2021-11-20T02:24:27","guid":{"rendered":"https:\/\/arknews.org\/?p=22971"},"modified":"2021-11-19T20:24:27","modified_gmt":"2021-11-20T02:24:27","slug":"state-sanctions-empower-says-medicaid-managed-care-company-misrepresented-facts","status":"publish","type":"post","link":"https:\/\/arknews.org\/index.php\/2021\/11\/19\/state-sanctions-empower-says-medicaid-managed-care-company-misrepresented-facts\/","title":{"rendered":"State sanctions Empower, says Medicaid managed care company \u2018misrepresented\u2019 facts"},"content":{"rendered":"<p><span style=\"\">The Arkansas Department of Human Services has suspended new enrollment for Empower Healthcare Solutions, a managed care organization serving about 20,000 Medicaid beneficiaries with intellectual or developmental disabilities, behavioral health disorders or both.<\/span><\/p>\n<p><span style=\"\">Empower is one of four <\/span><a href=\"http:\/\/www.aradvocates.org\/wp-content\/uploads\/AACF-PASSE.webfinal.12.10.18.pdf\"><span style=\"\">Provider-led Arkansas Shared Savings Entities<\/span><\/a><span style=\"\">, or PASSEs \u2014 managed care organizations that contract with the Arkansas Department of Human Services (DHS) to pay for and coordinate care for high-need, high-cost Medicaid clients. But recent turmoil within Empower has raised questions about whether the PASSE will have the capacity to keep operating in 2022. <\/span><a href=\"https:\/\/arknews.org\/index.php\/2021\/11\/06\/medicaid-managed-care-company-sues-outgoing-corporate-co-owner-alleging-sabotage\/\"><span style=\"\">Earlier this month<\/span><\/a><span style=\"\">, DHS gave it a deadline of Nov. 24 to complete a \u201cpartial readiness review.\u201d<\/span><\/p>\n<p><span style=\"\">On Tuesday, David Jones, a DHS Medicaid official, notified Empower that new enrollments to the PASSE would be suspended as of Friday, Nov. 19. \u201cThis sanction is imposed due to Empower\u2019s misrepresentation of information furnished to DHS,\u201d Jones wrote in <a href=\"http:\/\/arknews.org\/wp-content\/uploads\/2021\/11\/Empower-Sanction-Letter-11.15.2021.pdf\">a letter<\/a>.<\/span><\/p>\n<p><span style=\"\">A lawyer for Empower wrote <a href=\"http:\/\/arknews.org\/wp-content\/uploads\/2021\/11\/Empower-response.pdf\">a sharply worded reply<\/a> on Thursday, denying the PASSE had misled DHS and declaring the agency had acted illegally.<\/span><\/p>\n<p><span style=\"\">\u201cEmpower demands that DHS immediately retract the imposition of the sanction, which as you must know, will irreparably harm Empower,\u201d wrote Marshall Ney, an attorney with Friday Eldredge &amp; Clark LLP. \u201cAbsent this, Empower will be required to take all steps necessary to mitigate this harm, and as you know, DHS is not immune from suit for ultra vires acts such as this.\u201d (An ultra vires action is one taken beyond an entity\u2019s legal authority.)<\/span><\/p>\n<p><span style=\"\">PASSEs depend on enrollments for revenue. A PASSE plays the role of an insurance company, receiving a fixed monthly sum from DHS per each person it enrolls. The PASSE then pays for the cost of care for all its members, which can include costly services like inpatient treatment or at-home help for disabled people. The price tag can be huge: In 2020, Arkansas Medicaid paid out almost $1.3 billion for the state\u2019s roughly 50,000 PASSE beneficiaries, according to <\/span><a href=\"http:\/\/arknews.org\/wp-content\/uploads\/2021\/11\/Exhibit-F.1.pdf\"><span style=\"\">documents<\/span><\/a><span style=\"\"> provided to a legislative committee in June. (Empower's revenues for 2020 were over $460 million.)<\/span><\/p>\n<p><span style=\"\">Empower CEO Mitch Morris said in an email Friday that Empower typically receives about 150 new beneficiaries each month. About 20,000 members are enrolled in the PASSE as of now.<\/span><\/p>\n<p><span style=\"\">Empower\u2019s current problems are the result of its ongoing breakup with Beacon Health Options, a Boston-based company that is one of the nation\u2019s largest behavioral health organizations. Beacon has owned a 16.66% stake in Empower since the PASSE was formed in 2017. (The rest of Empower is owned by several health care entities based in Arkansas.) Beacon also contracts with Empower to provide administrative services and has played a critical role in Empower\u2019s day-to-day operations.<\/span><\/p>\n<p><span style=\"\">But in 2020, Beacon was acquired by insurance giant Anthem. Anthem also <\/span><a href=\"https:\/\/www.arkansasonline.com\/news\/2019\/sep\/15\/deal-sets-up-insurer-for-stakes-in-2-ma\/\"><span style=\"\">owns a stake<\/span><\/a><span style=\"\"> in another Arkansas PASSE, Summit Community Care, a rival of Empower. A <\/span><a href=\"https:\/\/www.arkleg.state.ar.us\/Bills\/FTPDocument?path=%2FBills%2F2021R%2FPublic%2FHB1515.pdf\"><span style=\"\">state law<\/span><\/a><span style=\"\"> passed earlier this year prohibited companies from owning portions of more than one PASSE, and Beacon soon began separating itself from Empower.<\/span><\/p>\n<p><span style=\"\">On Nov. 2, <\/span><a href=\"https:\/\/arknews.org\/index.php\/2021\/11\/06\/medicaid-managed-care-company-sues-outgoing-corporate-co-owner-alleging-sabotage\/\"><span style=\"\">Empower sued Beacon<\/span><\/a><span style=\"\">, accusing it of sabotaging Empower for the benefit of its new owner. The lawsuit claims Beacon has refused to turn over phone numbers, email accounts and critical databases and documents as the two companies worked towards finalizing their divorce at the end of the year. Empower and Beacon have also sparred over the issue of credentialing providers within Empower\u2019s provider network.<\/span><\/p>\n<p><span style=\"\">\u201cSince the merger, Beacon has engaged in conduct that suggests that it is functioning as a Trojan-horse for Anthem,\u201d Empower\u2019s complaint says. (The lawsuit was originally filed in federal court, but earlier this week the company withdrew it\u00a0 and refiled in Pulaski County Circuit Court. As of Friday, no hearing date had been set.)<\/span><\/p>\n<p><span style=\"\">The DHS sanction letter sent on Tuesday says the claims made by Empower in its lawsuit reveal that Beacon\u2019s departure has created far more problems for the PASSE than it had previously admitted to the state.<\/span><\/p>\n<p><span style=\"\">In July, \u201cEmpower identified certain areas that would change due to the transition away from Beacon,\u201d Jones, the Medicaid official, wrote. \u201cEmpower represented that the issues identified in the letter were the <\/span><b>only <\/b><span style=\"\">areas that were changing and, therefore, a full readiness review was not necessarily. DHS agreed to a partial readiness review based on Empower\u2019s representation[.]\u201d The letter then lists statements Empower made in its lawsuit that describe how Empower\u2019s business activities have been allegedly hobbled by Beacon.<\/span><\/p>\n<p><span style=\"\">Had DHS known Empower would lose access to phone numbers, email accounts and documents in the process of the divorce, \u201ca full readiness review would have been required,\u201d Jones wrote.<\/span><\/p>\n<p><span style=\"\">Empower\u2019s reply letter claims the PASSE has always kept DHS informed of its progress: \u201cEmpower has been cooperative, forthcoming, acted in good faith, and acted in the best interest of its members. Empower also has previously communicated to DHS, on multiple occasions, that Empower may have to seek legal action based on Beacon\u2019s uncooperative behavior.\u201d<\/span><\/p>\n<p><span style=\"\">Morris, the Empower CEO, continued to express optimism when asked for a response on Friday.<\/span><\/p>\n<p><span style=\"\">\u201cDespite the sanction, which will be dealt with by Empower in due course, the transition process with DHS is going extremely well from my perspective,\u201d he wrote in response to emailed questions.<\/span><\/p>\n<p><span style=\"\">Amy Webb, a spokeswoman for DHS, said Friday that the agency is \u201ccontinuing to monitor the situation closely and will provide more information to our clients as it becomes available.\u201d<\/span><\/p>\n<p><span style=\"\">If a PASSE cannot continue to participate in the program, Webb said, \u201cclients would be transitioned to another PASSE. With rare exception, PASSEs have the same providers in their networks, which would minimize disruptions for affected clients.\u201d<\/span><\/p>\n<p><span style=\"\">Loretta Cochran, a parent advocate, said moving to a new PASSE could nonetheless entail \u201ca huge change\u201d for clients and their families. Cochran is the mother of one PASSE beneficiary and the legal guardian of another (neither is enrolled in Empower or Summit).<\/span><\/p>\n<p><span style=\"\">\u201cTheoretically, all the PASSEs should have had the same provider networks and the same reimbursement relationships, so it would be seamless to move from one to the other,\u201d she said. But switching PASSEs could still require clients and their families to wade through paperwork, such as verifying their current health care providers are in-network, Cochran said.<\/span><\/p>\n<p><span style=\"\">\u201cIf I were an Empower parent, or client, now I have to go look at this big notebook \u2014 which may or may not be accurate \u2014 to see if the dentist I use, the mental health provider I use, the hospital I use, the pediatrician I use, the therapist I use, the psychiatrist I use, the pharmacy I use, the durable medical equipment company I use, that all those companies are in my new PASSE,\u201d she said. \u201cThese are medically complex people here.\u201d\u00a0<\/span><\/p>\n<p><span style=\"\">Cochran said changing care coordinators \u2014 which are employed by PASSEs to manage services for enrollees \u2014 could also create disruptions.<\/span><\/p>\n<p><span style=\"\">\u201cMy care coordinator can call my son, and they\u2019ll have a chat, and she\u2019ll figure out what to do. They have a great relationship now \u2014 that took years to build. That\u2019s not something you do on a dime, and not with someone who has communication challenges, particularly.\u201d<\/span><\/p>\n<p><span style=\"\">The uncertainty created for beneficiaries and families by the split between Beacon and Empower, she said, is \u201cunacceptable.\u201d<\/span><\/p>\n<p><span style=\"\">\u201cIf I were an Empower parent, man, I\u2019d be mad. I\u2019d be completely angry and hurt and scared, because the person I\u2019ve entrusted my child\u2019s life with \u2014 there\u2019s now a situation there,\u201d Cochran said.<\/span><\/p>\n<p><span style=\"\">In addition to Beacon, <\/span><a href=\"https:\/\/www.getempowerhealth.com\/about-us\/\"><span style=\"\">Empower is co-owned<\/span><\/a><span style=\"\"> by five other health care organizations. They are Arkansas Community Health Network, a consortium of four hospital systems; Statera, a long-term care company; Independent Case Management, a provider of home and community-based services for people with developmental disabilities; The Arkansas Healthcare Alliance, a group of providers for behavioral health and developmental disability services; and, ARcare, a network of clinics and other providers.<\/span><\/p>\n<p><span style=\"\">According to documents provided to a legislative committee in June, Empower has the largest share of beneficiaries among the four Arkansas PASSEs, with almost 20,000 members. Summit Community Care, the PASSE that is co-owned by Anthem, had more than 16,000 members. Arkansas Total Care, which is partially owned by health insurance company Centene, had over 13,000 members. The fourth PASSE is a newcomer to the state: CareSource PASSE, partially owned by an Ohio-based managed care company, was licensed earlier this year and is currently undergoing a readiness review.<\/span><\/p>\n<p><i><span style=\"\">This story is courtesy of <\/span><\/i><a href=\"http:\/\/arknews.org\/\"><i><span style=\"\">the Arkansas Nonprofit News Network<\/span><\/i><\/a><i><span style=\"\">, an independent, nonpartisan news project dedicated to producing journalism that matters to Arkansans.<\/span><\/i><\/p>\n","protected":false},"excerpt":{"rendered":"<p>The Arkansas Department of Human Services has suspended new enrollment for Empower Healthcare Solutions, a managed care organization serving about 20,000 Medicaid beneficiaries with intellectual or developmental disabilities, behavioral health disorders or both. Empower is one of four Provider-led Arkansas Shared Savings Entities, or PASSEs \u2014 managed care organizations that contract with the Arkansas Department [&hellip;]<\/p>\n","protected":false},"author":5,"featured_media":22974,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[111],"tags":[432,433,434,115,431],"class_list":["post-22971","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health-care","tag-beacon-health-options","tag-empower-healthcare-solutions","tag-managed-care","tag-medicaid","tag-passe"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v17.3 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>State sanctions Empower, says Medicaid managed care company \u2018misrepresented\u2019 facts - Arkansas Nonprofit News Network<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/arknews.org\/index.php\/2021\/11\/19\/state-sanctions-empower-says-medicaid-managed-care-company-misrepresented-facts\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"State sanctions Empower, says Medicaid managed care company \u2018misrepresented\u2019 facts - Arkansas Nonprofit News Network\" \/>\n<meta property=\"og:description\" content=\"The Arkansas Department of Human Services has suspended new enrollment for Empower Healthcare Solutions, a managed care organization serving about 20,000 Medicaid beneficiaries with intellectual or developmental disabilities, behavioral health disorders or both. Empower is one of four Provider-led Arkansas Shared Savings Entities, or PASSEs \u2014 managed care organizations that contract with the Arkansas Department [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/arknews.org\/index.php\/2021\/11\/19\/state-sanctions-empower-says-medicaid-managed-care-company-misrepresented-facts\/\" \/>\n<meta property=\"og:site_name\" content=\"Arkansas Nonprofit News Network\" \/>\n<meta property=\"article:published_time\" content=\"2021-11-20T02:24:27+00:00\" \/>\n<meta property=\"og:image\" content=\"http:\/\/arknews.org\/wp-content\/uploads\/2021\/11\/DHS-logo-centered.jpeg\" \/>\n\t<meta property=\"og:image:width\" content=\"1280\" \/>\n\t<meta property=\"og:image:height\" content=\"720\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Benjamin Hardy\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"7 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"Organization\",\"@id\":\"https:\/\/arknews.org\/#organization\",\"name\":\"Arkansas Nonprofit News Network\",\"url\":\"https:\/\/arknews.org\/\",\"sameAs\":[],\"logo\":{\"@type\":\"ImageObject\",\"@id\":\"https:\/\/arknews.org\/#logo\",\"inLanguage\":\"en-US\",\"url\":\"https:\/\/arknews.org\/wp-content\/uploads\/2021\/04\/annn_logo.png\",\"contentUrl\":\"https:\/\/arknews.org\/wp-content\/uploads\/2021\/04\/annn_logo.png\",\"width\":1200,\"height\":900,\"caption\":\"Arkansas Nonprofit News Network\"},\"image\":{\"@id\":\"https:\/\/arknews.org\/#logo\"}},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/arknews.org\/#website\",\"url\":\"https:\/\/arknews.org\/\",\"name\":\"Arkansas Nonprofit News Network\",\"description\":\"\",\"publisher\":{\"@id\":\"https:\/\/arknews.org\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/arknews.org\/?s={search_term_string}\"},\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"en-US\"},{\"@type\":\"ImageObject\",\"@id\":\"https:\/\/arknews.org\/index.php\/2021\/11\/19\/state-sanctions-empower-says-medicaid-managed-care-company-misrepresented-facts\/#primaryimage\",\"inLanguage\":\"en-US\",\"url\":\"https:\/\/arknews.org\/wp-content\/uploads\/2021\/11\/DHS-logo-centered.jpeg\",\"contentUrl\":\"https:\/\/arknews.org\/wp-content\/uploads\/2021\/11\/DHS-logo-centered.jpeg\",\"width\":1280,\"height\":720},{\"@type\":\"WebPage\",\"@id\":\"https:\/\/arknews.org\/index.php\/2021\/11\/19\/state-sanctions-empower-says-medicaid-managed-care-company-misrepresented-facts\/#webpage\",\"url\":\"https:\/\/arknews.org\/index.php\/2021\/11\/19\/state-sanctions-empower-says-medicaid-managed-care-company-misrepresented-facts\/\",\"name\":\"State sanctions Empower, says Medicaid managed care company \\u2018misrepresented\\u2019 facts - 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