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")
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.
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.