EATONTOWN, N.J., April 14 /PRNewswire-FirstCall/ -- QMed, Inc. today detailed the two key submission dates governing fulfillment of the Medicare Advantage Special Needs Plan (SNP) application and announced that the first key submission date of April 18th will be met. The SNP application is for its South Dakota project, which has replaced the Capitated Demonstration project. The application dates are April 18th and June 6th, 2005, respectively. The first date, April 18th, is for submission of the SNP plan formulary. The June 6th date is for submission of the complete plan benefit design. It includes physician and provider network agreements.
The Company had announced previously that the Centers for Medicare and Medicaid Services (CMS) shifted the Capitated Disease Management Demonstration to the regular Medicare Advantage application framework in order to bring it into conformity with the Medicare Modernization Act.
Michael W. Cox, president and CEO, said, "We are confident that we will meet the first milestone and expect to meet the second as well. As one would expect, network adequacy for care of members is a significant CMS criterion, as much under MMA as it was under the late demonstration. Given that nearly every physician and every hospital in South Dakota is contracted into the DAKOTACARE network, we believe that network adequacy will be a significant positive of the application."
"In our opinion," he continued, "the current opportunity provided to us by CMS could be considered superior in some important respects to the demonstration, not least in the potentially greater number of members that we could hope to enroll. In the demonstration, member enrollment would have been limited to a range of 3,000-5,000 enrollees. On the other hand, the risk- adjusted premium by contrast will not commence at 100% as would have been the case in the Capitated Demonstration, but will instead ramp as detailed in the regulations, in increments to the 100% level. The 2005 risk adjuster has been set at 50%. In January 2006 the risk adjuster will be 75%, and in January 2007 the risk adjuster will mature at the 100% rate."
"The MMA Special Needs Plan provision is a new approach by CMS this year, and CMS must review and approve our plan as being consistent with all applicable Medicare Advantage SNP requirements, as well as state insurance regulations which may be applicable to us and our partner DAKOTACARE. That said, the MMA provision is law, reflecting congressional and administration intent and we are pleased to have this chance to be considered for participation in this important Medicare reform. We are also pleased to advise shareholders that our two existing demonstrations with CMS continue to grow and produce interesting outcomes which may help to shed light on the ultimate use of Disease Management within CMS," he concluded.
About QMed, Inc.
QMed, Inc., provides DM services to patients and physicians around the country through its health plan customers. The Company has been selected in two Medicare Demonstrations to test the feasibility of reimbursing its care coordinated DM services in the vast Medicare fee-for-service program. In addition, QMed is the largest DM service provider to Medicare managed care plans. More information on QMed, Inc. can be obtained at http://www.qmedinc.com/, by calling (732) 544-5544 or by emailing investor@qmedinc.com.
Except for historical information contained herein, matters discussed in this news release are forward-looking statements that involve risks and uncertainties. They include but are not limited to those relating to the timely implementation of programs, the impact of competitive product introductions, acceptance and pricing, and those risks detailed in the Company's filings with the Securities and Exchange Commission (SEC). Actual results may differ materially from any forward-looking statements due to these risks and uncertainties.
QMed, Inc.CONTACT: Robert Mosby, QMed, Inc., +1-732-544-5544, ext. 1107
Web site: http://www.qmedinc.com/