Empower Healthcare Solutions, LLC (Empower) is a Provider-led Arkansas Shared Savings Entity (PASSE). This new model of care was developed to address the overall health care needs of Medicaid beneficiaries who have complex behavioral health or intellectual and developmental disability (IDD) service needs. Goals of the PASSE program are to:
Clinical Practice Guidelines
Current Clinical Practice Guidelines
In recent years, the process of developing clinical practice guidelines has undergone significant re-evaluation by national professional organizations including the American Medical Association and the Institute of Medicine. With an eye toward increasing rigor and improving transparency, these organizations have articulated principles that form the foundation for new standards of guideline development. The American Psychiatric Association (APA) and the American Academy of Child and Adolescent Psychiatry (AACAP) have both published statements on their websites in support of these new standards.
Empower Health Solutions has adopted clinical practice guidelines published by the APA, AACAP, and other professional organizations. This was based on their reputation as primary contributors and developers of guidelines representing acceptable standards of care at the time of origination.
Related to the continued evolution of clinical practice guideline development calling for higher standards of evidence, the industry currently has maintained or produced a limited number of guidelines that meet the new standards for guideline rigor and transparency. Accordingly, Empower has reviewed and adopted the following guidelines that meet those standards:
Contracting/Credentialing With Us
Contracting/Credentialing With Us
Empower Healthcare Solutions is excited to partner with Access Health under our Passe program in order to provide a higher level of care and care coordination services to all Medicaid beneficiaries receiving benefits.. The purpose of this model is to improve the health of those who need intensive levels of specialized care, link providers of physical health with specialty BH and DD providers and coordinate care for all community-based services.
Access Health Services
Access Health Services provides administrative services to health-related clients such as Medicare Advantage special needs plans, Medicaid support companies, non-governmental health plans, as well as small clinics, providers, or ancillary vendors.
Join Our Network
Any Provider of healthcare services who would like to become a participating provider with Empower must be enrolled in the Arkansas Medicaid Program before Empower can pay for services by the provider to the Arkansas Medicaid member. To become an Arkansas Medicaid Provider, please visit AR Medicaid Provider Enrollment by clicking here.
We appreciate your time and consideration in joining our networks and recognize that it is only through exceptional professionals like you that we can make high- quality health care more accessible to a greater number of people.
Cultural Competency Plan
Empower Healthcare Solutions (Empower) integrates cultural linguistic competency concepts into programs, services, policies and processes that reflect an understanding and respect for the diverse cultural and linguistic needs of members, providers, clients, staff members, and stakeholders in the provision of services. This includes individuals who have disabilities, limited English proficiency, specific populations such as Lesbian, Gay, Bisexual and Transgender (LGBT), and individuals who have diverse cultural and ethnic backgrounds.
Empower’s Cultural and Linguistic Program includes:
Availability of telephonic oral interpretation by staff or contracted vendor (if applicable) 24 hours, 7-day a week including American Sign Language (ASL) referral
Availability of TDD/TYY and/or relay services
Availability of referrals to network providers for services in specified language or for cultural needs
Translation of written materials as required or requested
Provision of member materials in plain language
Member testing of materials that includes review by representatives of the member population for which the materials/websites were designed, to ensure their readability, perceived usefulness, and that they appropriately address the cultural diversity of the target populations.
Mechanisms can include, but are not limited to, review by consumer members/advisory committees, or by focus groups, internal review by diverse staff, access to websites to practice and use tools. Results of such review are then incorporated into the final version of materials.
Login to the HHAeXchange Portal to take advantage of:
- FREE Electronic Visit Verification (EVV) tools
- Open Model EDI Integration with 3rd Party EVV Vendors
- Real-time, two-way messaging with each PASSE
- Receive recipient demographics, authorizations, and plan of care electronically
- Pre-bill scrubbing to ensure clean claims and accelerate revenue cycle
EVV and Claims Billing for Personal Care Providers visit HHAeXchange for FAQ’s, info sessions, trainings, and integration.
Fee Schedules, Codes, and Unique Modifiers
Provider Forms and Resources
Provider Authorizations Forms
Quality Improvement Resources
Providers Quality Improvement Activities
Empower Medical Record Documentation Review
Empower conducts an annual provider Medical Record Documentation Review (MRDR) as part of an ongoing commitment to promote continuous evaluation and improvement in quality of care, safety, and treatment outcomes for our members. In keeping with the guidelines outlined in the Arkansas PASSE Agreement, the MRDR is one of the quality improvement initiatives that the state mandates. Its purpose is to identify patient documentation practices that need improvement, so, they remain compliant with state and federal regulations and other quality standards. This is not a review of claims and billing practices, for the determination of medical necessity, or fraud, waste, and abuse of services rendered. However, if evidence of suspected fraud, waste and abuse is uncovered during the standard review of members’ medical records, Empower is obligated to thoroughly investigate the evidence further and report the findings to the appropriate authorities, including the Office of Medicaid Inspector General.
As announced in the June 2022 Provider Newsletter, Empower is set to launch the 2022 MRDR.
According to the “General Principles of Medical Record Documentation” by the Centers for Medicare and Medicaid Services (CMS), “the medical record chronologically documents the patient’s care and is an important element contributing to high-quality care.” CMS requires that every provider and practitioner of care creates and maintains electronic or paper medical records for every patient they render services to. Furthermore, all PASSE Providers are required to cooperate with all quality improvement initiatives by Empower. Medical records should be current, detailed, complete, accurate, legible, and organized to comply with federal and state regulations and standards. There are documentation requirements for different provider types (i.e., medical service providers, behavioral health providers, home and community-based service providers, and psychiatric residential treatment facilities). These guidelines are available for review by all providers in the applicable Arkansas Department of Human Services Medicaid Provider Manuals.
Empower members represent a unique niche in the healthcare services they utilize the most. These services can range from acute illness, injury, or exacerbation of a chronic condition to long-term residential care and disease management. The providers included for the 2022 MRDR gave the most comprehensive representation of the services utilized by the most members. The 2022 MRDR represents two provider groups and five subgroups. Behavioral Health Providers (i.e., psychiatrists only) and Primary Care Physicians have been and continue to be included, but the review has been expanded to include psychiatrists, licensed social workers, psychologists, pediatricians, and family medicine physicians.
Random selection methods are used to select from these provider types and records requests will be limited to members that have had at least three visits within the last year. Records should be submitted to Empower via encrypted/secure email or fax. Once all the records have been received, a systematic review of each medical record will be conducted utilizing a standard record review checklist.
Empower is using two different criteria checklists in the 2022 MRDR, the Behavioral Health Providers Checklist and the Primary Care Physicians Checklist. Each was developed from multiple sources using the criteria from state and federal regulatory standards as evidence-based guidelines for clinical practice. The PCP checklist includes additional clinical assessment components for both pediatric and adult members, and those needing obstetrical care.
2022 MRDR – Behavioral Health Providers Checklist
2022 MRDR – Primary Care Physicians Checklist
Once the review of records is complete a letter and a copy of the review scorecard will be sent to the participant. The letter will include recommendations for improvement, if applicable in specific areas that were identified during the review of the documentation submitted. No individual provider's results will be made public. However, providers that are found to have major deficits compared to the standards will need to submit a corrective action plan.
The complete MRDR Process is further detailed in the online 2022 MRDR Provider Training.
Checklists for Medical Record Documentation Review
An audit checklist that will be utilized for review of the documentation in the member records has been developed for the PCP records and a different checklist for the Behavioral Health Physician records.
The Checklists were developed utilizing standards identified in:
Manual for Empower Healthcare Solutions Providers;
Arkansas DHS Manuals;
Federal and state requirements (such as HIPAA and CMS standards; Arkansas Child and Adult Maltreatment Acts);
NCQA standards, best clinical practices, and Empower Clinical Practice Guidelines; and
National Accreditation standards.
All documentation in the member’s medical record for which the identified physician has medical responsibility may be reviewed as part of the audit. For example, if the selected Behavioral Health Physician provides services in an outpatient behavioral health program and is, therefore, medically responsible for all of the member’s behavioral healthcare, documentation of all services provided to the member is subject to review (not just the physician’s).
To see the Medical Record Documentation Review – Behavioral Health Physicians Checklist click here.
To see the Medical Record Documentation Audit – Primary Care Physician Checklist click here.
Revised Medical Record Documentation Review Timeline
In mid-December, providers who have been selected via a random sampling will receive a Notification Letter telling them that they have been selected to participate in the MRD Audit. The letter will include
A copy of the applicable MRD Audit Checklist (based upon provider type) that will be utilized
An explanation of the MRD Audit process
Information regarding record submission.
In the week following the mailing of the Notification Letters, Empower will reach out to those providers in order to obtain the contact information for the staff persons who will be responsible for providing requested records to Empower and the method that the provider plans to use to submit records.
At the beginning of January 2021, providers will receive a list of five (5) members whose records will be audited and a list of the requested documentation. Requested records must be submitted to Empower within fourteen (14) calendar days.
Providers may submit or give access to records utilizing several methods:
Direct access to the provider’s electronic medical records for the identified members
Secure File Transfer Protocol option, which will allow providers to upload records to a secure server (not yet available, but expected to be available by December).
When the audits are completed, feedback will be given to each provider whose records have been reviewed. Results from individual provider audits will not be published. Empower will aggregate the results of all record audits and review the data analysis of findings to identify key processes for quality improvement.
To see the Timeframes for Medical Record Documentation Audits click here.
Watch the Empower website for updates on the Medical Record Documentation Review!
COVID-19 and Other Communicable Diseases: Potential Quality of Care Review of Empower Provider Policies and Practices
The Quality Management Department is launching a Potential Quality of Care (QOC) review of Empower providers’ policies and practices relative to COVID-19 and other communicable diseases. This review is a part of Empower’s Quality Improvement process, which seeks to improve member care and treatment outcomes. Empower Staff and Providers have the responsibility to ensure the health and safety of individuals who are enrolled in the Arkansas Medicaid PASSE program and review concerns that place the health and safety of members at risk.
Because of the COVID-19 pandemic, Empower understands that our members are at risk of contracting the disease, as we have seen increasing numbers of our members with diagnoses of COVID-19. As with any communicable disease, our members are placed at risk by many factors, some of which include residing in group homes and facilities and staff coming and going from members’ homes and facilities in which they are receiving services.
With this heightened awareness and risk, Empower wants to insure that providers have:
Policies, procedures, protocols, and mitigation plans to prevent the spread of COVID-19 (and other communicable diseases) when there is a positive identification of provider staff or members
Policies, procedures, and plans to insure the continuation of treatment services for members when face-to-face contact is not recommended.
For the initial phase of this potential QOC review, Empower is sending letters requesting related policies, procedures, and plans to Psychiatric Residential Treatment Facilities and Intermediate Care Facilities. The letters will provide the details of the information that providers are asked to submit to Empower.
Empower appreciates the work and efforts made by our providers to ensure the health and safety of our members and your staff! Thank you!
MEDICAL RECORD DOCUMENTATION REVIEW
This Powerpoint will cover the Arkansas state-mandated provider Medical Records Documentation Review (MRDR) in June 2022. This is one of Empower's quality improvement initiatives to improve member care and treatment outcomes. The purpose of the MRDR is to identify areas that need improvement in a provider's medical record keeping so they stay in compliance with state and federal regulations and other established standards.
This webinar will cover Empower related information including provider responsibilities, provider resources, member rights and responsibilities, eligibility, covered services, utilization management, care coordination, claims submission, quality improvement, the Empower portal and more.
ACES AWARENESS PRESENTATION
This presentation will provide an overview of the Adverse Childhood Experiences (ACEs) tool and the importance of recognizing how adverse childhood experiences and trauma impact overall health and outcomes for adults.
Recommended audience is Clinicians, Case Managers, Mental Health Professionals, Clinical Directors and Nurses for Psychiatric Residential Treatment Facilities.