WellCare To Suspend Medicare Health Plans

Florida based WellCare, responding to a letter from Centers for Medicare & Medicaid Services, will suspend marketing of, and enrollments into, its Medicare health insurance plans.

WellCare had announced last year that it would offer a national Medicare Advantage drug plan starting in 2009. The Florida health insurance provider says in its release below that the current enrolled customers will not be effected by the CMS action.

The health insurance provider does not disclose the content of the CMS’s letter, but according to Florida based Sun-Sentinel “Medicare on Friday banned a leading health plan from enrolling new members because of persistent violations, such as misleading people about its coverage, not covering care and not solving complaints.”

The company writes that WellCare Health Plans, Inc. (NYSE: WCG) is working with the Centers for Medicare & Medicaid Services (“CMS”) to address issues raised by the agency in a letter that imposed sanctions on the Company’s Medicare Advantage plans and Medicare Prescription Drug Plans. By March 7, 2009, WellCare will suspend marketing of, and enrollments into, its Medicare health plans.

“We take CMS’ concerns very seriously,” said Heath Schiesser, WellCare’s President and Chief Executive Officer. “We are committed to complying fully with CMS requirements and serving the needs of our members.”

WellCare is making significant efforts to improve operational effectiveness to address the issues identified by both CMS and the Company’s own monitoring. WellCare will continue to devote substantial resources towards these initiatives, including engaging independent third parties to ensure that all of its operations and marketing activities are compliant with CMS’ requirements.

Current members of WellCare’s Medicare health plans are not affected by CMS’ action. Further, this action does not affect the Company’s Medicaid and S-CHIP plans. All plan members continue to have access to covered health care services.

This action arose from oversight and audits conducted by CMS. The Special Committee of the Board and the Company continue to cooperate fully in the separate investigations previously disclosed.

On September 25th of 2008 WellCare had announced that it would offer a national Medicare Drug plan starting in 2009.

Medicare beneficiaries may obtain more information about WellCare’s 2008 Medicare Part D PDP plans by calling WellCare at 888-547-5252 (TTY users call 888-816-5252) between 7:00 a.m. and 2:00 a.m. ET, seven days a week, or by visiting http://www.wellcarepdp.com. The web site includes information about the plans as well as a complete list of covered drugs and the pharmacy network of approximately 60,000 participating pharmacies. Information about 2009 plans is expected to be available after October 1, 2008.

WellCare Health Plans, Inc. provides managed care services exclusively for government-sponsored healthcare programs, focusing on Medicaid and Medicare. Headquartered in Tampa, Florida, WellCare offers a variety of health plans for families, children, the aged, blind and disabled and prescription drug plans. The Company served more than 2.5 million members nationwide as of September 30, 2008. For more information about WellCare, please visit the Company’s website at http://www.wellcare.com.

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Iowa Passes Health Care Expansion Legislation Without Mandate

The IowaSenate on Monday voted 42-6 to approve a bill (HF 2539) that would expand Hawk-Icoverage to tens of thousands more children, the DesMoines Register reports. Hawk-I is the state’s version of SCHIP. The legislation wouldincrease the income eligibility threshold from about $41,000 for a family offour to about $62,000.

The expansion would cost an estimated $5 million nextyear and about $25 million annually by 2011. The bill also would allow youngadult children to remain on their parents’ health insurance, encourage the useof electronic health records and create a consumer advocate position in the Iowa Insurance Division. The measure does not include amandate that all children have health coverage.

Details of the expansion would be determined by a commission, and the stateLegislature would consider the recommendations next year. The bill now movesback to the House, which approved similar legislation in March (Leys, DesMoines Register, 4/8).

Reprintedwith permission from kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, and sign upfor email delivery at kaisernetwork.org/email . The Kaiser Daily Health PolicyReport is published for kaisernetwork.org, a free service of The Henry J.Kaiser Family Foundation. � 2007 Advisory Board Company and Kaiser FamilyFoundation. All rights reserved.

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HHS Details Health Insurance Requirement Plan

The Department of Health and Human Services has released requirements for private health insurance companies to include prevent medicine. This is something that many Americans have been waiting for a long time. Several of the mandates cut costs to patients and increase the likelihood that patients will use preventive medicine. By using preventive medicine techniques, overall spending will decrease on treating common, preventable illnesses.

According to the website, these requirements apply to group health plans and group health insurance issuers for plan years beginning on September 23, 2010; and apply to individual health insurance issuers for policy years beginning on September 23, 2010.

The HHS health insurance requirements include evidence-based preventive services, routine vaccines, and women and children preventive medicine. The children’s preventive care requirement follows the Bright Futures Guidelines. These include pediatrician visits, vision and hearing screening, developmental assessments, immunizations, and obesity-related care. The developmental assessments requirement is great news with the rising rates in developmental disorders, such as autism, because they have long been denied by insurance companies. Parents can breathe easier that they will be able to have their child properly assessed and diagnosed. Women’s preventive medicine requirements are still under development and will be issued by August 1, 2011.

The best news of all is these health insurance companies cannot pass on costs to patients by preventing cost sharing, deductibles, co-pays and the like. According to a press release by the HHS department, 7 out of 10 American deaths are caused by heart disease, cancer, and diabetes, which are all preventable. With the decreased costs to patients, these deaths should decrease as patients avail themselves of now affordable health care.

“The Patient Protection and Affordable Care Act (the Affordable Care Act), Pub. L. 111-148, was enacted on March 23, 2010; the Health Care and Education Reconciliation Act (the Reconciliation Act), Pub. L. 111-152, was enacted on March 30, 2010. The Affordable Care Act and the Reconciliation Act reorganize, amend, and add to the provisions of part A of title XXVII of the Public Health Service Act (PHS Act) relating to group health plans and health insurance issuers in the group and individual markets” according to the HHS website.

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Iowa Bill To Increase Health Insurance Coverage For Children

Iowa Gov. Chet Culver (D)on Tuesday signed into law a bill (HF 2539) that provides an additional $25million over the next three years to extend coverage to more than 50,000uninsured Iowa children, the AP/ChicagoTribune reports. The law also sets the goalof establishing universal health coverage for all state residents within fiveyears. In addition, the law:

  • Allows children to stay on their parents’ health plans until age 25;
  • Establishes a medical records task force to study expanded use of electronic health records; and
  • Establishes standards to reduce the rate of childhood obesity in the state (Glover, AP/Chicago Tribune, 5/14).

Theprovisions included in the bill were based on recommendations by a bipartisancommission that was appointed by Culver to study improving health insuranceaccess (Beaumont, Des MoinesRegister,5/14).

In related news, Culver on Tuesday signed into law a $1.2 billion health andhuman services budget (SF 2425) that includes a 1% increase in Medicaidprovider payments. According to the AP/Tribune, the increase willgenerate $5.1 million to fund an increase in nurses’ salaries (Glover, AP/ChicagoTribune, 5/14). The bill also provides $5.5 million for hospitals tooffset their Medicaid costs, according to Culver (Des Moines Register,5/14).

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Program for young students increases interest in college attendance and medical careers

Two new studies have shown that a unique program in East Harlem that helps middle school students learn practical health skills and gain a better understanding of medical conditions, such as diabetes and hypertension, resulted in increased interest in college attendance and medical careers among the students who attended the program. The results were presented at the American Public Health Association (APHA) Annual Meeting this month in Denver. The MedStart Summer Enrichment Program was created in the summer of 2009 by Edward Chu and Melissa Schneiderman, two third-year medical students at Mount Sinai School of Medicine. The free, one-week summer program is offered to East Harlem middle-school students who are interested in science and medicine, or who would benefit from a more interactive approach to learning. MedStart provides the participants with CPR and First Aid certification, and teaches them practical skills, such as how to take a pulse, and measure blood pressure. The program also provides transit passes, lunch, T-shirts, and trophies, at no cost to the students, for completing the program.

“East Harlem has one of the highest rates of asthma, diabetes, and obesity in all of New York City,” said Chu. “We started the MedStart program because there was a significant unmet need for health care education among the youth of East Harlem about these diseases. A large number of medical students, residents, and faculty members were willing to dedicate time to help address this need, and MedStart was our solution.”

The research team behind MedStart evaluated the impact of the program and presented the results at the APHA meeting. One study evaluated the impact of student attitudes toward science and medical careers before and after the program. Thirty-eight students completed the pre-program survey and 37 completed the post-survey. At the conclusion of the program, there was a 31 percent increase in students who were “very interested” in science, a 23 percent increase in students who were “very interested” in a career in the medical field, and a 13 percent increase in students who thought it was important to attend college.

A second study evaluated improvement in student knowledge of diseases prevalent in their community—asthma, diabetes, obesity, and heart disease—by surveying 39 students before and after the program. Comparing the students’ pre-camp survey and post-camp survey performance, we found that their scores increased by an average of 26.5 percent. The majority of students previously were unaware of the high prevalence of these diseases in their community.

“These results demonstrate that the MedStart program improves middle school perceptions of health and science, encouraging them to someday consider careers in these fields,” said Stephanie H. Factor, MD, MPH, Assistant Professor of Medicine and faculty advisor for MedStart. “MedStart also educates these students at a critical time in their lives about prevalent diseases in the East Harlem community. The measurable impact of this program shows that it should be replicated in communities around the country.”

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