Empower Healthcare Solutions is here to help you with your health care. Empower works with you and your doctors. Our goal is to give you the best services and to improve your health. We also want you to be part of your care planning. Empower believes this will help you reach your life goals.
When you join Empower, you will have a Care Coordinator to help you with your health. Your Care Coordinator will work with you and your doctors. Working together, we can make sure you have the best care. Please read your handbook to get the most out of what we offer.
Getting great care is an important step to living a healthy and happy life.
AFMC PASSE Member Line
+1 (833) 402-0672
(PASSE Choice Counseling)
AFMC Member Service Center
+1 (800) 987-1200
(Eligibility Questions, Benefit Questions)
Office of the PASSE Ombudsman
There are four (4) ways to contact our office:
Division of Medical Services
Office of Ombudsman
P.O. Box 1437 Slot S-418
Little Rock, AR 72203-1437
DHS Office of Appeals and Hearing
+1 (501) 682-8622
(Appeals related to Medicaid and Medicaid Program Eligibility)
Empower Healthcare Solutions (Empower) Provider Relations
Toll-Free: (888) 274-7472
To Switch to Empower, call 1-833-402-0672
What is Care Coordination?
Care Coordination is when health care services and staff work together to make sure you get the best care. Everyone works together to create a Person Centered Service Plan (PCSP) to meet your care needs.
Your PCSP is made for you. It makes sure you have supports that know you. Your CC will be one person that all of your providers can talk to. They can share information about your care needs. The CC will make sure that the PCSP is being followed.
Care Coordination Services
Care Coordination will help members with their healthcare needs by making sure everyone works together. Care Coordination will include members in development of the PCSP. CC will also ensure compliance with the PCSP. Care Coordination will help with any resources needed or barriers to accessing treatment.
Your Care Coordinator will also:
Teach you more about your health needs
Help with any needs in your day to day life, such as helping you eat healthy food and exercise
Work with providers that give medicine
Work with providers to coordinator care
Make a plan of care that has all your services listed
Help find you services
Help you find supports in your family and community
Help if you are in trouble or in crisis
Provide guidance and support
Help with paperwork
Monitor providers to ensure that services are provided in a safe and helpful manner
Ensure you have an assigned PCP
Ensure you regularly follow up for prevention, wellness, and sick visits
Ensure all members have active coverage
Will follow up with you within 7 days of an ER, Urgent Care, or Hospital Admission
Will contact the member to assist with discharge planning, prescription assistance, follow up appointment with PCP and Specialty Providers
Person Centered Service Plan
Empower Healthcare Solution members have a PCSP. The Care Coordinator is responsible for obtaining copies of all treatment and service plans. The Care Coordinator will coordinate services between the plans. The goal is to prevent duplication of services. This will also identify any service gaps for the member. The Care Coordinator will also provide any health education and coaching needed. The Care Coordinator will ask members what goals they would like to achieve. The Care Coordinator will collect the member’s treatment plans and manage follow up.
It is your job to participate in the development of your PCSP. You can do so by providing the best information possible.
Your PCSP will include the following types of treatment or service plans:
Behavioral Health Treatment Plan
Person Centered Service Plan for Waiver Clients
Primary Care Physician Care Plan
Individualized Education Program
Individual Treatment Plans for developmental clients in day habilitation programs
Any existing Work Plan
Justice system-related plan
Child welfare plan
Medication Management Plan
Your PCSP will list what additional services are available to you. This may include:
Adult rehabilitative day service
Child and youth support services
Family support partners
Medication counseling by registered nurse
Mobile crisis intervention
Recovery support partners (for substance abuse)
Residential community reintegration program
Respite, emergency and planned
Substance abuse detox (observational)
Supportive life skills development
Therapeutic host homes
Your First Visit
At the first visit, you can expect the following from your Care Coordinator:
Introduction and Overview of Care Coordination
Contact Information for the Care Coordinator and Toll Free Number
Completion of the Healthcare Questionnaire
Discussion of Goals for Care Coordination
Obtain Release of Information for Providers and Support System
Healthcare Questionnaire which covers the following:
Complaints, Grievance, and Appeals
Complaints And Grievances
Empower cares about the care and the service we provide. If you are not happy with any part of your care, please call us at 1-866-261-1286 | TTY: 711 or email at ComplaintsAndGrievances@EmpowerArkansas.com and we will call you. Our goal is to help you with your complaint with a single call.
If you want to make complaint or grievance in person, you may come to:
Empower Healthcare Solutions
1401 West Capitol Avenue, Suite 430
Little Rock, AR 72201
If you need help filing a complaint/grievance, Empower can help you. Just call
1-866-261-1286 | TTY: 711.
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights on a computer through the Office for Civil Rights Complaint Portal, at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:
Copies of Complaint forms are at www.hhs.gov/ocr/office/file/index.html.
If you do not agree with a decision, you can ask for an appeal. You have 60 days from the date on the letter you receive to file an appeal. To ask for an appeal, you can call us at 1-866-261-1286 | TTY: 711. Oral appeal request must be followed with a written, signed appeal within ten (10) calendar days. You can also send a letter to:
Empower Healthcare Solutions
P.O. Box 211446
Eagan, MN 55121
You may also ask for an appeal in person at:
Empower Healthcare Solutions
1401 West Capitol Avenue, Suite 430
Little Rock, AR 72201
After we receive your appeal, EHS will review within 30 days. We will send a letter with results.
If waiting 30 days for a decision could be a risk, you can ask for a faster decision. This is called an expedited appeal. Empower Healthcare Solutions will decide about expedited appeals in 3 days.
If you need help with making an appeal, we can help. You can reach us by calling 1-866-261-1286 | TTY: 711.
If you ask, Empower Healthcare Solutions must continue to provide you benefits during the appeal process. For that to happen, the following must happen:
You can receive benefits until one of these items occur:
You withdraw the appeal
You withdraw the request for benefits
You do not ask for a fair hearing and you don’t ask to extend benefits within 10 days of Empower sending you a notice that the appeal was not decided in your favor
Please note that if you do not win the appeal, you may have to pay for services received during the appeal process.
Also, you may request a fair hearing and a continuation of benefits if not satisfied with the outcome of your appeal. This request must be made within 10 days after the PASSE sends you the notice of appeal decision.
Consumer Advisory Council
Empower recognizes the importance of engaging members in the PASSE program. We developed a Consumer Advisory Council(CAC) to help us with our programs. The CAC allows us help members live better.
Members and guardians are eligible to join the CAC. By serving on the Empower Consumer Advisory Council you can help improve the quality of services.
Empower invites our members to meet with us in person to share their opinions. During this meeting you can tell us what you think of the program. Empower uses this information to make program changes based on members’ needs. If you want to be a part of our Consumer Advisory Council email us at Consumer.Advisory@EmpowerArkansas.com.
Member Rights and Responsibilities
Company and Provider Information
You have the right to …
You have the right to …
Be part of decisions about your care plans, including your right to refuse treatment
Execute your advance directives without fear of being treated unfairly
Receive a copy of your rights and responsibilities
Tell us what you think your rights and responsibilities as a member should be
Be treated with respect, dignity, and privacy no matter what
Have anyone you choose to speak on your behalf
Decide who will make medical decisions for you if you cannot make them
Understand your Person-Centered Service Plan (PCSP) and receive the services listed in it
Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation
Live in an integrated and supported setting in the community and have control over aspects of your life
Be protected in the community
Exercise your rights without having the quality of your care affected
You have the right to …
Get information about services, benefits, or providers, care guidelines, and member rights and responsibilities
Receive written notice of changes regarding your care coordination provider within seven days
Receive a member handbook and provider directory soon after enrollment
Talk with your provider about your treatment options without cost or coverage being factors
Know about covered services, benefits, and decisions about health care payment with your plan, and how to find these services
Obtain information regarding your own treatment record with signed consent in a timely manner
Provide input to Empower
Request and receive a copy of your medical records and request that they be amended or corrected
Receive information on available treatment options and alternatives, and have this information given in understandable and appropriate way
Oral interpretation services free of charge for any Empower materials in any language
You have the right to …
Make complaints (verbally or in writing) about staff, services, or the care given by providers
Appeal if you disagree with a decision about your care. Empower administers your appeal rights as stipulated under your benefit plan
You have the right to …
Keep communication about your health information private
Access to Care, Services, & Benefits
You have the right to …
Receive timely care consistent with your need for care
Choose a participating provider for any service for which you are eligible and authorized to receive under your PCSP, including your primary care provider
Obtain needed, available, and accessible health care services covered under Empower
Claims and Billing
You have the right to …
Know the facts about any charge or bill you receive
You have the responsibility to …
Provide information, to the best of your ability, which Empower, or your provider may need to plan your treatment.
Learn about your condition and work with your provider to develop a plan for your care. You have the responsibility to follow the plans and instructions for care you have agreed to with your provider.
Understand your benefits, what is covered and what is not covered. You are responsible for understanding that you may be responsible for payment of services you receive that are not included in the Covered Services List for your coverage type.
Notify Empower and your provider of changes such as address changes, phone number change, or change in insurance.
Contact your Behavioral Health Provider, if you have one, if you are experiencing a mental health or substance use emergency.
If required by your benefit, you are responsible for choosing a primary care provider and site for the coordination of all your medical care.
Welcome! We are happy to have you as a member. We know that health insurance can be confusing, so the following are tools that should help you get the care you need from us.
Need to choose a Primary Care Provider (PCP)? If you don’t already have one who is in our network, we urge you to choose a PCP as soon as possible. To select or change your PCP call Member Services toll free at 1‑866‑261‑1286 | TTY:711 or contact your Care Coordinator at CareCoordination@EmpowerArkansas.com.
Our Utilization Management Procedures
Utilization management (UM), sometimes called utilization review, is the evaluation of the medical necessity, appropriateness, and efficiency of the use of healthcare services, procedures, and facilities under your health plan.
Empower covers all medically necessary Medicaid Services.
Most routine services, such as a visit with a PCP or specialist, do not need a prior authorization (PA). You may need a PA for certain procedures or surgeries, exceptions to the formulary (drug list), and requests for services outside of our provider network.
When you do need a PA, your provider makes the request for you. You do not need to contact Empower about this.
If you are admitted to a hospital, the facility must tell Empower Healthcare Solutions.
We offer Care Coordination services to all Empower members. This ensures that you receive appropriate and timely care.
Find complete utilization management information in your Member Handbook.
What Is This Document?
A Notice of Privacy Practices, tells you how Empower may use and share your health information. We must keep your health information private and secure. We will let you know if a breach occurs that affects the privacy or security of your information. The notice also explains how you can get access to your own health information.
What Is Health Information?
The words “health information” mean any information that identifies you. Examples include your name, date of birth, details about health care you received, or amounts paid for your care.
Why Are You Giving This to Me?
We are required by law to give you this notice. We must follow the practices in this notice. We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can share your information, you may change your mind at any time. Let us know in writing if you change your mind.
Who Follows This Notice?
All employees, contractors, consultants, vendors, volunteers, and other health care professionals and organizations who work with Empower follow this notice.
How We Can Use and Share Your Health Information
To Manage Your Health Care Treatment. We will use and share your health information to help with your health care.
For Example: A doctor sends us information about your diagnosis and treatment plan, so we can arrange for additional services.
For Example: We may share your health information with a service agency that arranges health care supportive housing services. For Health Care Operations.
To Help Us Do our Job. We may contact you when necessary. We are not allowed to use genetic information to decide whether we will give you coverage and the price of that coverage.
For Example: We use your health information to develop better services for you or to make sure you are receiving good services.
For Example: We submit data related to your health information to the state to show we are following our contract.
To Pay for your Health Services. We will use and share your health information as we pay for your health services.
For Example: We share information about you with your prescription plan to coordinate payment for your prescriptions. To Administer Your Plan. We may share your health information with other businesses for plan administration.
For Example: We share your information with a transportation company to make sure you get to your important appointment. With Business Associates. We may share your health information with another company, called a business associate, which we hire to provide a service to us or on our behalf. We will only share your information if the business associate has agreed in writing to keep health information private and secure.
Ways We Can Use or Share Your Health Information with Your Permission
You can choose how we share your information in the situations described below. Tell us what you want us to do and we will follow your instructions. If you are not able to tell us your preference, we may go ahead and share your information if we believe it is in your best interest.
Individuals Involved in Payment for Your Care. We may share your health information with your family members, friends or other people who are involved in your health care or who help pay for it. You have the right to ask that we not share your information with certain people, but you must let us know. Information About health-Related Benefits, Services and Treatment Alternatives. We may tell you about health services, products, possible treatments or alternatives available to you.
Sensitive Information. Some types of medical information are very sensitive. The law may require that we obtain your written permission to share this information. Sensitive medical information may include genetic testing, HIV/AIDS testing, diagnosis or treatment, mental health, alcohol and substance abuse, sexual assault or in-vitro fertilization. Your permission is also required for the use and sharing of psychotherapy notes.
Use of Your Information for Our Marketing. We may not use or disclose your health information for marketing purposes unless we have your written permission.
Sale of Your Information. We will not sell your health information unless we have your written permission.
How We Must Share Your Health Information
We also have to share your information in situations that help contribute to the public good or safety. We have to meet many conditions in the law before we can share your information for these purposes.
Research. We can use or share your information for health research.
Public Health and Safety. We may share your health information for public health and safety reasons. For example:
To prevent or control disease
To help report information about bad products
To report adverse reactions to medications
To let you know that you may have been exposed to a disease or may be at risk for getting or spreading a disease or condition
To your employer in certain limited instances.
Abuse and Neglect. We may have to share your information to report suspected abuse, neglect or domestic violence to state and federal agencies. You will likely be told that we are sharing this information with these agencies.
For Disaster Relief. We may share your health information in a disaster relief situation.
Prevent a Serious Threat to Safety. We may use and share your medical information to prevent or reduce a serious threat to your health and safety or the health and safety of others.
Comply with the Law. We must share health information about you when we are required to do so by federal or state laws.
As a Part of Legal Proceedings. We can share health information about you in response to a court order or a subpoena. We will only share the information stated in the order. If we receive any other legal requests, we may share your health information if we are told that you know about it and do not object to the release.
With Law Enforcement. We must share health information about you when we are required to do so by law or by the court process, including for the following:
To identify or locate a suspect, fugitive, material witness or missing person
To obtain information about an actual or suspected victim of a crime
We may also share information with law enforcement if we believe a death was the result of a crime or to report crimes on our property or in an emergency.
During an Investigation. We will share your information with the Secretary of the Department of Health and Human Services if they ask for it as part of an investigation of a privacy violation.
Special Governmental Functions. We may share your health information with:
Authorized federal officials
For intelligence, counter-intelligence and other national security activities
To protect the president
Coroners, Medical Examiners and Funeral Directors. We may share health information with a coroner or medical examiner to identify a dead person or find the cause of death. We also may share health information with funeral directors if they need it to do their job.
Health Oversight Activities. Certain health agencies are in charge of overseeing health care systems and government programs or to make sure that civil rights laws are being followed. We may share your information with these agencies for these purposes.
Organ and Tissue Donation. If you are an organ donor, we may release health information to the organizations in charge of getting, transporting or transplanting an organ, eye or tissue.
Workers Compensation. We may share your health information with agencies or individuals to follow workers compensation laws or other similar programs.
Your Rights Regarding Your Health Information
You Have a Right to Request Restrictions. You have the right to ask us to limit the ways we use and share your health information for treatment, payment, and health care operations. We do not have to agree if it would affect your care. You must submit your request in writing, and it must be signed and dated. You should describe the information you want limited and tell us who should not receive this information.
You must submit your written request to Empower@EmpowerArkansas.com.
We will tell you if we agree with your request or not. If we do agree, we will follow your request unless the information is needed to treat you in an emergency. If we do not agree we will discuss our concerns with you in order to better understand how we can help you.
You Have a Right to Get a Copy of Health and Claims Records. You have the right to read or get a copy of your health and claims records and other health information we have about you. To see and obtain copies of your information you must complete your request in writing. We will give you a copy or a summary of your health and claims record within 30 days of your request. If you request a copy of your health and claims record, we may charge a reasonable, cost-based fee for the costs of copying, mailing or other expenses associated with your request.
You Have a Right to Request Changes. You may ask us to change your health information or payment record if you think it is incorrect or incomplete. You must send us a written request and you must provide the reason why you want the change. We are not required to agree to make the change. If we do not agree to the requested change, we will tell you why in writing within 60 days. You may then send another request disagreeing with us. It will be attached to the information you wanted changed or corrected.
You Have a Right to Request Confidential Communication. You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address. We will consider all reasonable requests. We must agree if you tell us you would be in danger if we do not follow your request.
You have the right to make a written request for a list of the times we have shared your health information in the past six years. The list will have who we shared it with, the date it was shared and why. We will include all the disclosures except for those about treatment, payment, and health care operations and any disclosure you asked us to make. We will provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months. Your written request must designate a time period. You have the right to ask for a paper copy of this notice at any time. We will provide you with a paper copy promptly.
You Have a Right to Choose Someone to Act For You. If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority and can act for you before we take any action.
Changes To This Notice We may change our privacy policies, procedures, and this Notice at any time, and the changes will apply to all information we have about you. If we change this Notice, the new Notice will be posted on our web site.
Seeking Healthcare Services
Selecting a Primary Care Provider (PCP)
It is important for you to have a main doctor. This is called your Primary Care Provider (PCP). They manage your overall health care needs. They provide services such as annual exams, routine shots (vaccines), and office visits for illnesses and injuries.
PCPs include family practice doctors, general practitioners, internists, and pediatricians. If you need help, your Empower Care Coordinator can help you find a PCP in your area.
To select or change your PCP, you can call Empower Member Services at
1-866-261-1286 | TTY:711 or contact your Care Coordinator directly. Members that have both Medicare and Medicaid can keep their existing Medicare PCP if desired.
Access to Care
When you need care, call your Care Coordinator first. You can reach them 24/7. If you need them between 5 p.m. and 8 a.m., please call 1-866-261-1286 | TTY:711. They will help you manage all of your health services. If you think you need to see a special doctor or another doctor, talk with your PCP. You do not need a referral from your PCP to get services.
It is important that you keep all appointments you make for doctor visits, lab tests, or X-rays. Please call your PCP at least one day ahead of time if you cannot keep an appointment.
If you need help in making an appointment, please contact your Care Coordinator directly or Empower Member Services at
1-866-261-1286 | TTY:711
Reaching Your PCP After Hours
PCPs have 24-hour answering services or they have a telephone recording. The answering services or recording will instruct you on how to receive care after regular office hours.
Urgent care is for a health issue that need care right away but would cause death. Urgent care is not emergency care. You will require a prior approval from Empower if you go to an Urgent Care clinic not in Empower’s network. Examples of urgent care are:
Minor Cuts and scrapes
An emergency medical condition is very serious. It could even cause death. You could have severe pain, injury or illness. If you have an emergency call 9-1-1 immediately.
Examples of Emergencies
What You Can Do in Case of an Emergency
Go to the nearest Emergency Department; you can use any hospital or other setting to get emergency services
Call ambulance if no 9-1-1 service is in the area
No authorizations are needed in emergencies
No referral is needed
Prior authorization is not needed, but as soon as your condition is stable you should call your Care Coordinator to assist in arranging follow-up care
Empower covers all medically necessary Medicaid services. We cover the services at no cost to you. Some services require prior authorization from Empower. Your healthcare provider will submit any needed prior authorizations. You do not need to contact us about this. Empower will not deny services due to moral or religious issues.
Covered services include:
Adult developmental day treatment services
Advanced nurse practitioners and registered nurse practitioner services
Ambulatory surgical center services
Critical access hospital
Early and periodic screening and diagnosis of individuals under 21 years of age and treatment of conditions found
End-stage renal disease facility services
Factor 8 injections
Family Planning Services
Federally qualified health center services
Hearing aid dealer services
Hearing aids, accessories, and repairs
Home Health services
Inpatient hospital services
Intellectual disability services in an intermediate care facility (other than in an Institution for Mental Diseases)
Maternity clinic services (limited to services before and after childbirth)
Mentally retarded care in intermediate care facilities
Nurse anesthetist services
Obstetric-gynecologic and gerontological nurse practitioner services
Optical lab services
Outpatient hospital services
Outpatient surgical procedures
Pacemakers and internal surgical prostheses
Pediatric or family nurse practitioners’ services
Pregnancy care, extended services
Private duty nursing
Psychiatric inpatient services for individuals under age 21
Physical therapy and related services
Rehabilitative Services – Outpatient behavioral health services; Tier 1 services
Rehabilitative hospital services – Extended
Respiratory care services
Rural health clinic services
Tobacco cessation counseling
Early and Periodic Screening, Diagnosis and Treatment (EPSDT)
Early and Periodic Screening, Diagnosis and Treatment (EPSDT) is a federally mandated Medicaid program developed to ensure that the Medicaid population younger than the age of 21 is monitored for preventable and treatable conditions which, if undetected, could result in serious medical conditions and/or costly medical care. Empower will track the progress of all members younger than the age of 21 and perform outreach as needed to encourage members to obtain EPSDT health screens according to the American Academy of Pediatrics Guidelines for screening intervals. Once a condition is detected, treatment may be considered under EPSDT Special/Expanded Services if it is not a current covered benefit under Medicaid, if medical necessity is proven. EPSDT preventive health screens that result in any treatment recommendations must be monitored to ensure follow up has occurred.
Family Planning Services
Empower has many Family Planning doctors where you can get family planning services. We cover the cost of contraceptives, including birth control devices and the fitting or insertion of the device (such as IUDs and implants). You can get services from any qualified family planning provider. He/she does not have to be a network provider. You do not need a referral from your PCP and you do not have to get permission from Empower to get these services.
A provider network is a list of health care providers that the PASSE contracted with to provide health care to members. Empower members are encouraged to receive care from providers and hospitals that are in network with Empower. You must have prior approval from Empower to visit out-of-network providers. The only exceptions are for treatment of emergencies and for family planning services.