{"id":23006,"date":"2022-02-04T21:23:11","date_gmt":"2022-02-05T03:23:11","guid":{"rendered":"https:\/\/arknews.org\/?p=23006"},"modified":"2022-02-04T21:26:34","modified_gmt":"2022-02-05T03:26:34","slug":"state-regulators-give-ok-to-medicaid-managed-care-company-once-dogged-by-investigations","status":"publish","type":"post","link":"https:\/\/arknews.org\/index.php\/2022\/02\/04\/state-regulators-give-ok-to-medicaid-managed-care-company-once-dogged-by-investigations\/","title":{"rendered":"State regulators give OK to Medicaid managed care company once dogged by investigations"},"content":{"rendered":"<p><span style=\"\">Two months ago, things were looking dire for Empower Healthcare Solutions, a managed care organization that serves roughly 20,000 Arkansas Medicaid beneficiaries with developmental disabilities, severe behavioral health disorders and other complex needs.<\/span><\/p>\n<p><span style=\"\">The attorney general\u2019s office was <\/span><a href=\"https:\/\/arknews.org\/index.php\/2021\/12\/03\/state-investigates-managed-care-company-empower-for-alleged-medicaid-fraud\/\"><span style=\"\">investigating the company for suspected Medicaid fraud<\/span><\/a><span style=\"\">. The state Department of Human Services, which oversees Medicaid in Arkansas, <\/span><a href=\"https:\/\/arknews.org\/index.php\/2021\/11\/19\/state-sanctions-empower-says-medicaid-managed-care-company-misrepresented-facts\/\"><span style=\"\">suspended new enrollments to Empower<\/span><\/a><span style=\"\"> in November due to alleged \u201cmisrepresentations\u201d to DHS. And Empower was undergoing <\/span><a href=\"https:\/\/arknews.org\/index.php\/2021\/11\/06\/medicaid-managed-care-company-sues-outgoing-corporate-co-owner-alleging-sabotage\/\"><span style=\"\">an acrimonious corporate divorce<\/span><\/a><span style=\"\"> with one of its co-owners, Beacon Health Options, which Empower\u2019s lawyers said was trying to \u201csabotage\u201d Empower on its way out the door.<\/span><\/p>\n<p><span style=\"\">Now, Empower looks to be in the clear with state regulators \u2014 and has found a new financial backer in the form of a Dallas private equity firm.<\/span><\/p>\n<p><span style=\"\">On Monday, <a href=\"http:\/\/arknews.org\/wp-content\/uploads\/2022\/02\/DHS-Empower-Readiness-Review-letter.pdf\">DHS notified Empower CEO Mitch Morris that the company had officially passed a months-long \u201creadiness review\u201d process.<\/a> DHS officials initiated the review last year out of concern that Empower might not have been prepared to continue serving its members in the wake of its separation from Beacon, one of the nation\u2019s largest behavioral health companies.\u00a0<\/span><\/p>\n<p><span style=\"\">In addition to owning a 16.67% share of Empower, Beacon played a critical role in its day-to-day operations and provided key administrative services.<\/span><\/p>\n<p><span style=\"\">An independent consultant who reviewed Empower\u2019s operational capacity in November on behalf of DHS found \u201csignificant concerns\u201d about Empower\u2019s transition away from Beacon. \u201cThe number and seriousness [of] issues identified without doubt draw into question Empower\u2019s current readiness to carry out required \u2026 functions,\u201d <a href=\"http:\/\/arknews.org\/wp-content\/uploads\/2022\/02\/Anthony-Rodgers-letter-Final-Empower-Readiness-Assessment-12_02_2021-tr-pdf.pdf\">he wrote in a Nov. 30 letter to DHS<\/a>.\u00a0<\/span><\/p>\n<p><span style=\"\">However, that consultant ultimately recommended DHS allow Empower to keep operating in 2022, on a conditional basis, while it continued to monitor the company. With the readiness review now complete, Empower is able to resume enrolling Medicaid beneficiaries\u00a0 \u2014 and thus bring in more revenue.<\/span><\/p>\n<p><span style=\"\">Empower is the largest of four so-called Provider-led Arkansas Shared Savings Entities (PASSEs), organizations that contract with DHS to pay for and coordinate care for high-need, high-cost Medicaid beneficiaries. PASSEs must be majority owned by health care providers, but their role is similar to that of insurance companies. Each PASSE receives a fixed monthly sum from DHS for each of its members \u2014 the equivalent of a premium. The PASSE is then responsible for paying for care for all its members, which can include costly services like inpatient psychiatric treatment or around-the-clock help for people with disabilities. In 2020, Medicaid paid out almost $1.3 billion to PASSEs for the roughly 50,000 beneficiaries in the system, 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. About 20,000 of those are Empower members.<\/span><\/p>\n<p><span style=\"\">\u201cWe are happy to achieve full and final approval and look forward to continued collaboration with DHS,\u201d Morris said in an emailed response to questions. He said Empower was \u201cfully staffed and strongly positioned for continued operations.\u201d<\/span><\/p>\n<p><span style=\"\">The letter DHS sent to Morris says the agency \u201cwill continue to monitor Empower and will hold regular meetings with Empower for enhanced monitoring.\u201d<\/span><\/p>\n<p><span style=\"\">Empower is also free of the Medicaid fraud investigation. On Jan. 4, the attorney general\u2019s office <\/span><a href=\"https:\/\/content.govdelivery.com\/accounts\/ARAG\/bulletins\/303f5ae\"><span style=\"\">announced it had reached an almost $8 million civil settlement with Empower<\/span><\/a><span style=\"\">, which denies wrongdoing.\u00a0<\/span><\/p>\n<p><span style=\"\">Morris said the company\u2019s issues with the attorney general\u2019s office \u201chave been fully resolved.\u201d<\/span><\/p>\n<p><span style=\"\">On Friday, Empower also completed a deal with a new co-owner: <\/span><a href=\"https:\/\/www.trivecapital.com\/\"><span style=\"\">Trive Capital<\/span><\/a><span style=\"\">, a Dallas-based private equity firm. After gaining approval from the Arkansas Insurance Department \u2014 which regulates PASSEs to ensure they are financially solvent \u2014 Trive acquired the 16.67% share of Empower left behind by Beacon. The separation of Beacon and Empower was completed on Dec. 31, Morris said.<\/span><\/p>\n<p><span style=\"\">At an Insurance Department hearing Friday afternoon, Tanner Cope, a managing director at Trive, said the two sides had expected to close the deal by the end of the year but were delayed by the attorney general investigation and the DHS readiness review.\u00a0<\/span><\/p>\n<p><span style=\"\">Morris said Trive and Empower began discussing the acquisition last summer. He declined to answer a question about the terms of the deal or the amount Trive was initially investing in the Arkansas company.<\/span><\/p>\n<p><span style=\"\">Asked whether Empower families should be concerned that a private equity firm had acquired a portion of their PASSE, Morris said no. \u201cEmpower\u2019s #1 priority is always to provide industry-leading services and support to our members and their families. With these changes, Empower is better positioned to do so,\u201d he wrote.<\/span><\/p>\n<p><span style=\"\">Trive did not respond to calls or emails on Friday seeking comment.<\/span><\/p>\n<p>Trive will join <a href=\"http:\/\/arknews.org\/wp-content\/uploads\/2022\/02\/Anthony-Rodgers-letter-Final-Empower-Readiness-Assessment-12_02_2021-tr-pdf.pdf\">the five Arkansas-based health care organizations that now co-own Empower<\/a>: <span style=\"\">Arkansas Community Health Network, a consortium of 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><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>Two months ago, things were looking dire for Empower Healthcare Solutions, a managed care organization that serves roughly 20,000 Arkansas Medicaid beneficiaries with developmental disabilities, severe behavioral health disorders and other complex needs. The attorney general\u2019s office was investigating the company for suspected Medicaid fraud. The state Department of Human Services, which oversees Medicaid in [&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":[195,433,115,431,443],"class_list":["post-23006","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health-care","tag-arkansas-department-of-human-services","tag-empower-healthcare-solutions","tag-medicaid","tag-passe","tag-trive-capital"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v17.3 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>State regulators give OK to Medicaid managed care company once dogged by investigations - 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\/2022\/02\/04\/state-regulators-give-ok-to-medicaid-managed-care-company-once-dogged-by-investigations\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"State regulators give OK to Medicaid managed care company once dogged by investigations - Arkansas Nonprofit News Network\" \/>\n<meta property=\"og:description\" content=\"Two months ago, things were looking dire for Empower Healthcare Solutions, a managed care organization that serves roughly 20,000 Arkansas Medicaid beneficiaries with developmental disabilities, severe behavioral health disorders and other complex needs. The attorney general\u2019s office was investigating the company for suspected Medicaid fraud. 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