Changes were effected in the pharmacology of COPD with code 491 for chronic bronchitis, 492 for emphysema and 496 to stand for COPD. The changes required that tests, screening and care be instituted for an ED encounter, or a patient who has been discharged from an acute inpatient admission, if they had been primarily diagnosed with COPD (HEDIS/CAPHS REPORT, 2013). They are to be given both a bronchodilator within 30 days, and a within 14 days of the event. Asprin was also included in the management. This included members over age 40, who had been diagnosed with COPD between Jan 1 and Nov 30 of 2012. Also, the changes required members more than age 40 with a new diagnosis of COPD to have the disease confirmed. In addition, the promotion health staff were to monitor the populations in order to assist in filling the prescriptions. According to the NCQAs (2012) health insurance rankings, the pharmacotherapy management of COPD, testing for COPD and spirometry with COPD are both included under Medicaid plans.

The insurance company chosen is Coventry Healthcare of Florida, Inc. It is an accredited type, Medicaid, health management organization. It has not scored as per HEDIS and CAHPS, but overall, it is accredited. Its accreditation is derived from easy accessibility of services and qualified health providers. Its accreditation as per the previous review will expire on 05/14/2017. The next review date is scheduled to be 21/14/2017 (NCQA, 2014).

References

HEDIS/CAPHS REPORT. (2013). Comparative analysis of audited results from MCOs. Retrieved from http://www.tn.gov/tenncare/forms/hedis13.pdf

NCQA.(2012). NCQAs health insurance plan rankings 2012-2013 methodology overview. Washington, DC: Author.

NCQA.(2014). Health plan reports card. Retrieved from http://reportcard.ncqa.org/plan/external/PlanList.aspx?name=&state=FL&zipcode=-1&plantype=2&statename=Florida