United Healthcare of Mississippi Inc. and United Behavioral Health Inc. v. Mississippi's Community Mental Health Commissions, Region One Mental Health ("Region 1"); North MS Commission on Ml/MR d/b/a Communicare ("Region 2"); Northeast Mental Health-Mental Retardation Commission, Region III d/b/a Lifecore Health Group ("Region 3"); Region IV Mental Health Services d/b/a Timberhills ("Region 4"); Region 6 Community Mental Health Commission, d/b/a Life Help ("Region 6"); Region VII Mental Health/Intellectual Disabilities Commission d/b/a Community Counseling Services ("Region 7"); Region 8 Mental Health Services ("Region 8"); Hinds Behavioral Health Services ("Region 9"); Region 10 State of MS d/b/a Weems Community Mental Health Center ("Region 10"); Southwest Mississippi Mental Health and Retardation Commission-Region 11 d/b/a Southwest Mississippi Mental Health Complex ("Region 11"); Region XII Commission on Mental Health and Retardation d/b/a Pine Belt Mental Healthcare Resources ("Region 12"); Gulf Coast Mental Health Center ("Region 13"); Singing River Mental Health/Mental Retardation Services, Region XIV ("Region 14"); and Warren Yazoo Behavioral Health, Inc. ("Region 15")

CourtMississippi Supreme Court
DecidedMarch 24, 2022
Docket2020-CA-00697-SCT
StatusPublished

This text of United Healthcare of Mississippi Inc. and United Behavioral Health Inc. v. Mississippi's Community Mental Health Commissions, Region One Mental Health ("Region 1"); North MS Commission on Ml/MR d/b/a Communicare ("Region 2"); Northeast Mental Health-Mental Retardation Commission, Region III d/b/a Lifecore Health Group ("Region 3"); Region IV Mental Health Services d/b/a Timberhills ("Region 4"); Region 6 Community Mental Health Commission, d/b/a Life Help ("Region 6"); Region VII Mental Health/Intellectual Disabilities Commission d/b/a Community Counseling Services ("Region 7"); Region 8 Mental Health Services ("Region 8"); Hinds Behavioral Health Services ("Region 9"); Region 10 State of MS d/b/a Weems Community Mental Health Center ("Region 10"); Southwest Mississippi Mental Health and Retardation Commission-Region 11 d/b/a Southwest Mississippi Mental Health Complex ("Region 11"); Region XII Commission on Mental Health and Retardation d/b/a Pine Belt Mental Healthcare Resources ("Region 12"); Gulf Coast Mental Health Center ("Region 13"); Singing River Mental Health/Mental Retardation Services, Region XIV ("Region 14"); and Warren Yazoo Behavioral Health, Inc. ("Region 15") (United Healthcare of Mississippi Inc. and United Behavioral Health Inc. v. Mississippi's Community Mental Health Commissions, Region One Mental Health ("Region 1"); North MS Commission on Ml/MR d/b/a Communicare ("Region 2"); Northeast Mental Health-Mental Retardation Commission, Region III d/b/a Lifecore Health Group ("Region 3"); Region IV Mental Health Services d/b/a Timberhills ("Region 4"); Region 6 Community Mental Health Commission, d/b/a Life Help ("Region 6"); Region VII Mental Health/Intellectual Disabilities Commission d/b/a Community Counseling Services ("Region 7"); Region 8 Mental Health Services ("Region 8"); Hinds Behavioral Health Services ("Region 9"); Region 10 State of MS d/b/a Weems Community Mental Health Center ("Region 10"); Southwest Mississippi Mental Health and Retardation Commission-Region 11 d/b/a Southwest Mississippi Mental Health Complex ("Region 11"); Region XII Commission on Mental Health and Retardation d/b/a Pine Belt Mental Healthcare Resources ("Region 12"); Gulf Coast Mental Health Center ("Region 13"); Singing River Mental Health/Mental Retardation Services, Region XIV ("Region 14"); and Warren Yazoo Behavioral Health, Inc. ("Region 15")) is published on Counsel Stack Legal Research, covering Mississippi Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

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United Healthcare of Mississippi Inc. and United Behavioral Health Inc. v. Mississippi's Community Mental Health Commissions, Region One Mental Health ("Region 1"); North MS Commission on Ml/MR d/b/a Communicare ("Region 2"); Northeast Mental Health-Mental Retardation Commission, Region III d/b/a Lifecore Health Group ("Region 3"); Region IV Mental Health Services d/b/a Timberhills ("Region 4"); Region 6 Community Mental Health Commission, d/b/a Life Help ("Region 6"); Region VII Mental Health/Intellectual Disabilities Commission d/b/a Community Counseling Services ("Region 7"); Region 8 Mental Health Services ("Region 8"); Hinds Behavioral Health Services ("Region 9"); Region 10 State of MS d/b/a Weems Community Mental Health Center ("Region 10"); Southwest Mississippi Mental Health and Retardation Commission-Region 11 d/b/a Southwest Mississippi Mental Health Complex ("Region 11"); Region XII Commission on Mental Health and Retardation d/b/a Pine Belt Mental Healthcare Resources ("Region 12"); Gulf Coast Mental Health Center ("Region 13"); Singing River Mental Health/Mental Retardation Services, Region XIV ("Region 14"); and Warren Yazoo Behavioral Health, Inc. ("Region 15"), (Mich. 2022).

Opinion

IN THE SUPREME COURT OF MISSISSIPPI

NO. 2020-CA-00697-SCT

UNITED HEALTHCARE OF MISSISSIPPI INC. AND UNITED BEHAVIORAL HEALTH INC.

v.

MISSISSIPPI’S COMMUNITY MENTAL HEALTH COMMISSIONS, REGION ONE MENTAL HEALTH (“REGION 1”); NORTH MS COMMISSION ON ML/MR D/B/A COMMUNICARE (“REGION 2”); NORTHEAST MENTAL HEALTH-MENTAL RETARDATION COMMISSION, REGION III D/B/A LIFECORE HEALTH GROUP (“REGION 3”); REGION IV MENTAL HEALTH SERVICES D/B/A TIMBERHILLS (“REGION 4”); REGION 6 COMMUNITY MENTAL HEALTH COMMISSION, D/B/A LIFE HELP (“REGION 6”); REGION VII MENTAL HEALTH/INTELLECTUAL DISABILITIES COMMISSION D/B/A COMMUNITY COUNSELING SERVICES (“REGION 7”); REGION 8 MENTAL HEALTH SERVICES (“REGION 8”); HINDS BEHAVIORAL HEALTH SERVICES (“REGION 9”); REGION 10 STATE OF MS D/B/A WEEMS COMMUNITY MENTAL HEALTH CENTER (“REGION 10”); SOUTHWEST MISSISSIPPI MENTAL HEALTH AND RETARDATION COMMISSION-REGION 11 D/B/A SOUTHWEST MISSISSIPPI MENTAL HEALTH COMPLEX (“REGION 11”); REGION XII COMMISSION ON MENTAL HEALTH AND RETARDATION D/B/A PINE BELT MENTAL HEALTHCARE RESOURCES (“REGION 12”); GULF COAST MENTAL HEALTH CENTER (“REGION 13”); SINGING RIVER MENTAL HEALTH/MENTAL RETARDATION SERVICES, REGION XIV (“REGION 14”); AND WARREN YAZOO BEHAVIORAL HEALTH, INC. (“REGION 15”) DATE OF JUDGMENT: 06/08/2020 TRIAL JUDGE: HON. ELEANOR JOHNSON PETERSON TRIAL COURT ATTORNEYS: GEORGE H. RITTER JOHN P. SNEED CHARLES EDWARD COWAN TIMOTHY JOHN STERLING LAUREN RUTH HILLERY CHARLES G. COPELAND REBECCA SUZANNE BLUNDEN COURT FROM WHICH APPEALED: HINDS COUNTY CIRCUIT COURT ATTORNEYS FOR APPELLANTS: TIMOTHY JOHN STERLING CHARLES G. COPELAND REBECCA SUZANNE BLUNDEN ATTORNEYS FOR APPELLEES: GEORGE H. RITTER CHARLES EDWARD COWAN JOHN P. SNEED NATURE OF THE CASE: CIVIL - CONTRACT DISPOSITION: AFFIRMED - 03/24/2022 MOTION FOR REHEARING FILED: MANDATE ISSUED:

CONSOLIDATED WITH

NO. 2020-IA-00683-SCT

UNITED HEALTHCARE OF MISSISSIPPI INC. AND UNITED BEHAVIORAL HEALTH INC.

v. MISSISSIPPI’S COMMUNITY MENTAL HEALTH COMMISSIONS: REGION ONE MENTAL HEALTH (“REGION 1”), NORTH MS COMMISSION ON MI/MR D/B/A COMMUNICARE (“REGION 2”), NORTHEAST MENTAL HEALTH- MENTAL RETARDATION COMMISSION, REGION III D/B/A LIFECORE HEALTH GROUP (“REGION 3”), REGION IV MENTAL HEALTH SERVICES D/B/A TIMBERHILLS (“REGION 4”), REGION 6 COMMUNITY MENTAL HEALTH COMMISSION D/B/A LIFE HELP (“REGION 6”), REGION VII MENTAL HEALTH/INTELLECTUAL DISABILITIES COMMISSION D/B/A COMMUNITY COUNSELING SERVICES (“REGION 7”), REGION 8 MENTAL HEALTH SERVICES (“REGION 8”), HINDS BEHAVIORAL HEALTH SERVICES (“REGION 9”), REGION 10 STATE OF MS D/B/A WEEMS COMMUNITY MENTAL HEALTH CENTER (“REGION 10”), SOUTHWEST MISSISSIPPI MENTAL HEALTH AND RETARDATION COMMISSION- REGION 11 D/B/A SOUTHWEST MISSISSIPPI MENTAL HEALTH COMPLEX (“REGION 11”), REGION XII COMMISSION ON MENTAL HEALTH AND RETARDATION D/B/A PINE BELT MENTAL HEALTHCARE RESOURCES (“REGION 12”), GULF COAST MENTAL HEALTH CENTER (“REGION 13”), SINGING RIVER MENTAL HEALTH/MENTAL RETARDATION SERVICES, REGION XIV (“REGION 14”) AND WARREN YAZOO BEHAVIORAL HEALTH, INC. (“REGION 15”)

DATE OF JUDGMENT: 06/08/2020 TRIAL JUDGE: HON. ELEANOR JOHNSON PETERSON COURT FROM WHICH APPEALED: HINDS COUNTY CIRCUIT COURT ATTORNEYS FOR APPELLANTS: CHARLES G. COPELAND REBECCA SUZANNE BLUNDEN TIMOTHY JOHN STERLING

3 ATTORNEYS FOR APPELLEES: GEORGE H. RITTER JOHN P. SNEED CHARLES EDWARD COWAN NATURE OF THE CASE: CIVIL - CONTRACT DISPOSITION: AFFIRMED AND REMANDED - 03/24/2022 MOTION FOR REHEARING FILED: MANDATE ISSUED:

BEFORE RANDOLPH, C.J., COLEMAN AND CHAMBERLIN, JJ.

RANDOLPH, CHIEF JUSTICE, FOR THE COURT:

¶1. In 2012, United Healthcare of Mississippi (United) entered into provider agreements

with Mississippi’s fourteen Community Mental Health Centers (CMHCs) to provide

Medicaid services under the Division of Medicaid’s (DOM’s) managed care program

established under Mississippi Code Section 43-13-117(H) (Rev. 2021). From 2012 until

2019, United paid the CMHCs an agreed upon amount for Medicaid services—100 percent

of the medicaid fee schedule rates. In July 2019, United unilaterally imposed a 5 percent rate

cut, retroactive to January 1, 2019, and later demanded that the CMHCs refund 5 percent of

all payments made from July 1, 2018, through December 31, 2018, all of which totaled more

than $1 million. The CMCHs demanded that United immediately cease and desist from the

5 percent rate cut and recoupments. When United refused, the CMHCs filed a Complaint for

Damages and Injunctive Relief in the Circuit Court of the First Judicial District of Hinds

County, specifically requesting, inter alia, a preliminary injunction.

¶2. United responded with a motion to compel arbitration and to stay the proceedings.

After a two-day evidentiary hearing, the circuit court denied United’s motion to compel

arbitration, granted the CMHCs’ request for injunctive relief, and issued a preliminary

4 injunction.

¶3. The limited issues presented to this Court are whether the trial court properly enjoined

United from imposing a 5 percent rate cut and whether the trial court erred by denying

arbitration. For the reasons set forth below, we affirm the trial court’s decision to grant a

preliminary injunction and to deny the motion to compel arbitration. We remand for

proceedings consistent with this opinion.

FACTS AND PROCEDURAL HISTORY

¶4. Mississippi has fourteen regional health commissions established under Mississippi

Code Sections 41-19-31 and -33 (Rev. 2018). Each regional commission operates a CMHC

to provide facilities and services for the prevention and treatment of mental illnesses, mental

disorders, developmental and learning disabilities, alcoholism, narcotic addiction, drug

dependence, and related conditions. All CMHCs participate in Mississippi’s Medicaid

program.

¶5. The state of Mississippi contracts with managed care organizations (MCOs) or

coordinated care organizations (CCOs) to provide Medicaid services through its Mississippi

Coordinated Acess Network or “MississippiCAN” program. United is one of those MCOs.

United is paid to enter into provider agreements with network providers that provide

necessary services at agreed rates. In turn, United, rather than the state, reimburses providers

for healthcare services rendered to the Mississippi beneficiaries enrolled with United. In its

contract with the state of Mississippi, United was instructed to develop and implement

innovative payment models that incentivize improvements in healthcare quality, outcomes,

5 or value, as determined by the DOM. See Miss. Code Ann. § 43-13-117(H)(l)(c) (Rev. 2021).

Subsection (H)(l)(c) places a condition on the negotiated rates: “As a condition for the

approval of any program under this subsection (H)(l), the division shall require that no

program may . . . (c) [p]ay providers at a rate less than the normal Medicaid reimbursement

rate.”

¶6. As part of the program, Mississippi pays United a capitation fee, which is a set fee

based on the number of members enrolled in United’s Medicaid health plan. In exchange for

that fee, United assumes the risk that it will incur a loss if the cost of the health services it

provides exceeds the capitation fee. Mississippi pays United a capitation fee of

approximately $718,870,179 annually to provide services to patients enrolled in its

MississippiCAN health plans. In 2018, United’s parent company reported revenues of more

than $226 billion and net earnings of more than $11.9 billion.

¶7.

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United Healthcare of Mississippi Inc. and United Behavioral Health Inc. v. Mississippi's Community Mental Health Commissions, Region One Mental Health ("Region 1"); North MS Commission on Ml/MR d/b/a Communicare ("Region 2"); Northeast Mental Health-Mental Retardation Commission, Region III d/b/a Lifecore Health Group ("Region 3"); Region IV Mental Health Services d/b/a Timberhills ("Region 4"); Region 6 Community Mental Health Commission, d/b/a Life Help ("Region 6"); Region VII Mental Health/Intellectual Disabilities Commission d/b/a Community Counseling Services ("Region 7"); Region 8 Mental Health Services ("Region 8"); Hinds Behavioral Health Services ("Region 9"); Region 10 State of MS d/b/a Weems Community Mental Health Center ("Region 10"); Southwest Mississippi Mental Health and Retardation Commission-Region 11 d/b/a Southwest Mississippi Mental Health Complex ("Region 11"); Region XII Commission on Mental Health and Retardation d/b/a Pine Belt Mental Healthcare Resources ("Region 12"); Gulf Coast Mental Health Center ("Region 13"); Singing River Mental Health/Mental Retardation Services, Region XIV ("Region 14"); and Warren Yazoo Behavioral Health, Inc. ("Region 15"), Counsel Stack Legal Research, https://law.counselstack.com/opinion/united-healthcare-of-mississippi-inc-and-united-behavioral-health-inc-v-miss-2022.