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  • Writer's pictureThe San Juan Daily Star

Health secretary appeals to US Congress to address gaps in Medicare Advantage coverage

Health Secretary Carlos Mellado López

By The Star Staff

Health Secretary Carlos Mellado López on Wednesday sent a letter to U.S. congressmen requesting that the Puerto Rico government’s lack of jurisdiction when it comes to supervising insurers under Medicare Advantage contracts be addressed.

“We need legislative action and the support of U.S. Health Secretary Xavier Becerra to strengthen the regional office of the Centers for Medicare and Medicaid Services (CMS), the Department of Health and the Insurance Commissioner of Puerto Rico,” Mellado said in a written statement.

In his letter, addressed to 27 members of Congress, Mellado called for an increase in “permanent” funding and for addressing federal health plan coverage gaps for U.S. citizens living on the island. He also urged that Puerto Rico be included in poverty-related incentives and adjustments based on regional factors such as the Average Geographic Adjustment.

Mellado said Medicare Advantage rates in Puerto Rico were 24% below the national average in 2011, and are now 41% below the national average, 37% below Hawaii, the lowest state, and 22% below the U.S. Virgin Islands. The Health chief also asked the Department of Health and Human Services (HHS) and CMS to develop specific policies to address the irregular and unfair practices in Puerto Rico’s health system, which he said contradicts the local government’s efforts to retain medical professionals on the island.

“Puerto Rico is the only jurisdiction in which the local Medicaid program does not pay the monthly premium of $164.94 of Medicare Part B for dual-eligible beneficiaries,” Mellado said.

Currently, about 648,000 Medicare Advantage beneficiaries reside on the island.

In addition, the Health secretary noted that the prevalence of diabetes in Puerto Rico is 19.5% compared to 10% in the continental United States. The cost of living in Puerto Rico is high, and more than half of the population lives below the federal poverty level, he pointed out.

Recently, the Mellado and the Health Insurance Administration sent a notice of fines to the four insurers of the Vital Plan, as the Medicaid-funded government health plan is called, for almost $100 million.

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