Attorney General's News Release

December 19, 2002

Nixon reaches settlement with HMO to provide extra $1.1 million in lead screening in 2003 for St. Louis-area children

Jefferson City, Mo. — Attorney General Jay Nixon today announced he has reached an agreement with Healthcare USA of Missouri for the health maintenance organization to spend $1,131,000 above and beyond its contractual obligation to the state to conduct leading screening on St. Louis-area children who are Medicaid recipients.

The settlement resolves a lawsuit brought by the Attorney General asserting that Healthcare USA breached a 1997 contract with the state under the MC+ program by failing to test St. Louis children enrolled in Medicaid for lead poisoning. Nixon filed suit in November 1999 against Healthcare USA of Missouri and Prudential Health Care Plan Inc.; Healthcare USA countersued the state in July 2000. The lawsuit against Prudential is still pending.

"This settlement provides increased and much-needed lead screening for children who are in a high at-risk group," Nixon said. "With the high percentage of older homes in the St. Louis metropolitan area that still contain lead paint, we need to do everything possible to safeguard the health and well-being of the children who live in those homes."

Nixon said failure to screen had significant effects in St. Louis, where the number of older homes with lead-based paint exceeds national averages. The principal source of lead contamination for children is lead-based paint used in older homes; in some areas of St. Louis, the percentage of houses built before 1950 is as high as 80 percent.

Medicaid rules require that all children be tested for lead at the age of 12 months and again at the age of 24 months. The 1999 lawsuit alleged that Healthcare USA tested only 29 percent of the children at the 12-month level and 17 percent at the 24-month level in 1998. Lead poisoning "at or above level of concern" adversely affects a child's mental and physical development and can result in damage to the central nervous system, kidneys, and blood producing organs, as well as behavioral problems and decreased intelligence and mental retardation. At high levels it can result in coma, convulsions and death.

The HMOs contracted with the state for a package of services provided to the children, including lead testing of children at 12 months and 24 months and significant follow-up services for those children who tested positive for lead, including hospitalization and chelation treatment in severe cases. Healthcare USA and Prudential were specifically required to conduct blood lead testing for all enrollees at ages 12 months and 24 months. If a child's blood level is above certain established thresholds, the HMOs must provide follow-up services including:

• Nutritional and educational intervention;
• Pharmacological treatment;
• Environmental investigation;
• Medical treatment (including hospitalization and chelation therapy; and
• Outreach to parents to establish a process for ensuring that treatment continues and testing schedules are met, and transportation to and from facilities, if needed.

Besides the $1,131,000 in additional screening, today's settlement also calls for Healthcare USA to make a charitable donation of $10,000 to the Missouri Lead Coalition Task Force.

Inquiries from consumers should be directed to consumer@ago.mo.gov or 1-800-392-8222 (from within Missouri) or 573-751-3321 (outside Missouri).

All media inquiries should be directed to Press Secretary John Fougere.

E-mail      Phone: 573-751-8844         Fax: 573-751-5818