Southern Kentucky circuit judge was probably the first to die in Tenn. from fungal meningitis outbreak stemming from tainted steroids

Judge Eddie C. Lovelace

The first person to die in Tennessee from the nine-state meningitis outbreak liked to bad steroids was most likely Kentucky Circuit Judge Eddie C. Lovelace of Albany, 78, who died at Vanderbilt University Medical Center Sept. 17. John Dreyzehner, Tennessee's commissioner of health, said Friday that the number of Tennesseans affected by the meningitis outbreak has now risen to 29. The number of deaths is unchanged at three. The search for more affected patients will continue "for some time," he said. Investigators haven't found evidence that the clinics or clinicians in Tennessee did anything to cause the outbreak, which has been reported in other states.

In July and August, Lovelace received three rounds of the pain-relieving steroid injections suspected of causing the outbreak of the rare disease, Joyce Lovelace, his wife of 55 years, told Adam Tamburin of The Tennessean. Representatives of the Saint Thomas Hospital Outpatient Neurosurgery Center, where he received the injections, are reported to have called Joyce Lovelace twice after his death to discuss his condition. They did not mention the outbreak, she said, nor have they confirmed that that was his cause of death.

Vanderbilt spokespeople have confirmed to the newspaper that "the first reported casualty of the outbreak was a 78-year-old man who died there on Sept. 17." Doctors told his family that his unexpected death was likely caused by a stroke, which is common among critically ill meningitis patients. His symptoms -- slurred speech, trouble walking and numbness -- are consistent with symptoms of fungal meningitis.

Lovelace had been a circuit court judge for two decades, and commonwealth's attorney and county attorney before that. “He always wanted to be known as a judge who knew the law, and he certainly was.” Joyce Lovelace said. “His career was not over. He had years yet to work.” (Read more) Democratic Gov. Steve Beshear may fill Lovelace's nonpartisan vacancy with state Sen. David Williams of Burkesville, who has been president of the Senate since Republicans took formal control of the chamber in 2000.

UPDATE, Oct. 6: The New York Times reports that nine states have reported meningitis cases connected to the steroids made by a Massachusetts company, which shipped the steroids to 14 other states. "Some doctors and clinics have turned away from major drug manufacturers and have taken their business to so-called compounding pharmacies, like New England Compounding, which mix up batches of drugs on their own, often for much lower prices than major manufacturers charge — and with little of the federal oversight of drug safety and quality that is routine for the big companies." (Read more) New England Compounding has recalled the steroids, The Tennessean reports.

Judge Eddie C. Lovelace

The first person to die in Tennessee from the nine-state meningitis outbreak liked to bad steroids was most likely Kentucky Circuit Judge Eddie C. Lovelace of Albany, 78, who died at Vanderbilt University Medical Center Sept. 17. John Dreyzehner, Tennessee's commissioner of health, said Friday that the number of Tennesseans affected by the meningitis outbreak has now risen to 29. The number of deaths is unchanged at three. The search for more affected patients will continue "for some time," he said. Investigators haven't found evidence that the clinics or clinicians in Tennessee did anything to cause the outbreak, which has been reported in other states.

In July and August, Lovelace received three rounds of the pain-relieving steroid injections suspected of causing the outbreak of the rare disease, Joyce Lovelace, his wife of 55 years, told Adam Tamburin of The Tennessean. Representatives of the Saint Thomas Hospital Outpatient Neurosurgery Center, where he received the injections, are reported to have called Joyce Lovelace twice after his death to discuss his condition. They did not mention the outbreak, she said, nor have they confirmed that that was his cause of death.

Vanderbilt spokespeople have confirmed to the newspaper that "the first reported casualty of the outbreak was a 78-year-old man who died there on Sept. 17." Doctors told his family that his unexpected death was likely caused by a stroke, which is common among critically ill meningitis patients. His symptoms -- slurred speech, trouble walking and numbness -- are consistent with symptoms of fungal meningitis.

Lovelace had been a circuit court judge for two decades, and commonwealth's attorney and county attorney before that. “He always wanted to be known as a judge who knew the law, and he certainly was.” Joyce Lovelace said. “His career was not over. He had years yet to work.” (Read more) Democratic Gov. Steve Beshear may fill Lovelace's nonpartisan vacancy with state Sen. David Williams of Burkesville, who has been president of the Senate since Republicans took formal control of the chamber in 2000.

UPDATE, Oct. 6: The New York Times reports that nine states have reported meningitis cases connected to the steroids made by a Massachusetts company, which shipped the steroids to 14 other states. "Some doctors and clinics have turned away from major drug manufacturers and have taken their business to so-called compounding pharmacies, like New England Compounding, which mix up batches of drugs on their own, often for much lower prices than major manufacturers charge — and with little of the federal oversight of drug safety and quality that is routine for the big companies." (Read more) New England Compounding has recalled the steroids, The Tennessean reports.

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Four companies will oversee Medicaid coverage in 16-county Louisville region that includes 175,000 Kentuckians

Beginning Jan. 1, four companies will share management of the health care of roughly 175,000 Medicaid patients in the Jefferson County region. This reflects a major, federally mandated change that some say raises concerns about disrupting care. The nonprofit Passport Health Plan has served all Medicaid recipients in the 16-county region for 15 years. On Thursday, the state Cabinet for Health and Family Services said it had signed 18-month contracts with Passport and three other companies -- Humana, Wellcare of Kentucky and Coventry Cares -- to manage Medicaid recipients’ care starting next year. Other details of the contracts were not released.

The federal government has made it clear that the state it could no longer operate with a single managed-care company in the region and that it must give patients a choice among several providers. In addition to Jefferson, the region’s other counties are Breckinridge, Bullitt, Carroll, Grayson, Hardin, Henry, LaRue, Marion, Meade, Nelson, Oldham, Shelby, Spencer, Trimble and Washington.

According to The Courier-Journal's Tom Loftus, "Passport had hoped that, if the state went with multiple companies, it initially would assign all recipients to it and then give them an option of moving to another company. Instead, the cabinet initially will assign recipients to one of the four companies. The cabinet said the state will use 'a high-tech matching system' that assigns a person based on 'available provider networks and any special health care needs.' (Read more)

Andrea Bennett, deputy director of Kentucky Youth Advocates, said the new system raises concerns for child advocates. "While we still have threads of hope, we cannot ignore the ongoing Medicaid managed care issues that have occurred throughout the rest of the state over the past year.  . . . We’ve heard providers threaten to give up on Medicaid altogether because they are frustrated and still not receiving proper payment. We’ve seen lawsuits and fights between the state, the managed care companies, and the providers. And we still haven’t seen hard data showing how managed care is improving quality and access to care for children in the Commonwealth."

Beginning Jan. 1, four companies will share management of the health care of roughly 175,000 Medicaid patients in the Jefferson County region. This reflects a major, federally mandated change that some say raises concerns about disrupting care. The nonprofit Passport Health Plan has served all Medicaid recipients in the 16-county region for 15 years. On Thursday, the state Cabinet for Health and Family Services said it had signed 18-month contracts with Passport and three other companies -- Humana, Wellcare of Kentucky and Coventry Cares -- to manage Medicaid recipients’ care starting next year. Other details of the contracts were not released.

The federal government has made it clear that the state it could no longer operate with a single managed-care company in the region and that it must give patients a choice among several providers. In addition to Jefferson, the region’s other counties are Breckinridge, Bullitt, Carroll, Grayson, Hardin, Henry, LaRue, Marion, Meade, Nelson, Oldham, Shelby, Spencer, Trimble and Washington.

According to The Courier-Journal's Tom Loftus, "Passport had hoped that, if the state went with multiple companies, it initially would assign all recipients to it and then give them an option of moving to another company. Instead, the cabinet initially will assign recipients to one of the four companies. The cabinet said the state will use 'a high-tech matching system' that assigns a person based on 'available provider networks and any special health care needs.' (Read more)

Andrea Bennett, deputy director of Kentucky Youth Advocates, said the new system raises concerns for child advocates. "While we still have threads of hope, we cannot ignore the ongoing Medicaid managed care issues that have occurred throughout the rest of the state over the past year.  . . . We’ve heard providers threaten to give up on Medicaid altogether because they are frustrated and still not receiving proper payment. We’ve seen lawsuits and fights between the state, the managed care companies, and the providers. And we still haven’t seen hard data showing how managed care is improving quality and access to care for children in the Commonwealth."

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Did the ancient Egyptians domesticate the cat?

Kurushima JD, Ikram S, Knudsen J, Bleiberg E, Grahn RA and Lyons LA. Cats of the pharaohs: Genetic comparison of Egyptian cat mummies to their feline Contemporaries. Journal of Archaeological Science. 2012; 39: 3217-23.
 
Ancient Egyptian culture is well known for its reverence and mummification of cats based on art and skeletal remains dating back to about 4000 BC. From this historical association between man and cat, many scholars concluded that the ancient Egyptians likely domesticated our present day feline companions. However, an archeological finding in Cyprus of a potential wildcat buried with a human dates to approximately 7500 BC, before the Predynastic Egyptian period. Additionally, recent genetic studies have suggested that the origins of cat domestication occurred in the adjacent Near Eastern sites including the Fertile Crescent regions. The origin of cats in Egypt may have arisen via trade through the Near East as already domesticated animals.

Mummification of cats (and other animals) was a long-standing tradition in ancient Egypt, reaching its zenith during the Late Period (664-332 BC). Cat mummies can be divided into four categories: pets, revered gods (e.g., Bastet the cat goddess and protectress), food offerings, and votive (i.e. vow) offerings. The majority of offerings found in Egypt and museums are of the votive type. Genetic analyses in this study included two long bones (dated from about 664 BC to 250 AD) and a mandible (dated from about 400 BC to 200 AD) from three mummified cats of the votive type. After identifying a portion of mitochondrial DNA with sufficient variability to distinguish among various modern wild cats and domestic cat mitotypes, overcoming the antagonism of the votive mummification process to PCR chemistry, and in spite of the environmental insult to the mummy remains through antiquity, these authors were able to successfully amplify DNA from Egyptian cat mummies for the first time. Their research supports the view that cats, revered by the ancient Egyptians, were likely Felis silvestris catus (domestic cats) implying cats were domesticated prior to extensive votive mummification. [GO]

See also: Gnudi G, Volta A, Manfredi S, Ferri F and Conversi R. Radiological investigation of an over 2000-year-old Egyptian mummy of a cat. J Feline Med Surg. 2012; 14: 292-4.

More on cat health:
Winn Feline Foundation Library
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Kurushima JD, Ikram S, Knudsen J, Bleiberg E, Grahn RA and Lyons LA. Cats of the pharaohs: Genetic comparison of Egyptian cat mummies to their feline Contemporaries. Journal of Archaeological Science. 2012; 39: 3217-23.
 
Ancient Egyptian culture is well known for its reverence and mummification of cats based on art and skeletal remains dating back to about 4000 BC. From this historical association between man and cat, many scholars concluded that the ancient Egyptians likely domesticated our present day feline companions. However, an archeological finding in Cyprus of a potential wildcat buried with a human dates to approximately 7500 BC, before the Predynastic Egyptian period. Additionally, recent genetic studies have suggested that the origins of cat domestication occurred in the adjacent Near Eastern sites including the Fertile Crescent regions. The origin of cats in Egypt may have arisen via trade through the Near East as already domesticated animals.

Mummification of cats (and other animals) was a long-standing tradition in ancient Egypt, reaching its zenith during the Late Period (664-332 BC). Cat mummies can be divided into four categories: pets, revered gods (e.g., Bastet the cat goddess and protectress), food offerings, and votive (i.e. vow) offerings. The majority of offerings found in Egypt and museums are of the votive type. Genetic analyses in this study included two long bones (dated from about 664 BC to 250 AD) and a mandible (dated from about 400 BC to 200 AD) from three mummified cats of the votive type. After identifying a portion of mitochondrial DNA with sufficient variability to distinguish among various modern wild cats and domestic cat mitotypes, overcoming the antagonism of the votive mummification process to PCR chemistry, and in spite of the environmental insult to the mummy remains through antiquity, these authors were able to successfully amplify DNA from Egyptian cat mummies for the first time. Their research supports the view that cats, revered by the ancient Egyptians, were likely Felis silvestris catus (domestic cats) implying cats were domesticated prior to extensive votive mummification. [GO]

See also: Gnudi G, Volta A, Manfredi S, Ferri F and Conversi R. Radiological investigation of an over 2000-year-old Egyptian mummy of a cat. J Feline Med Surg. 2012; 14: 292-4.

More on cat health:
Winn Feline Foundation Library
Find us on Facebook
Follow us on Twitter
Join us on Google+

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UK and Purdue researchers find a compound in watermelon that fights 'bad' cholesterol and arterial plaque in lab rats

A study from the University of Kentucky and Purdue University showed that mice fed a diet including watermelon juice had lower weight, cholesterol and arterial plaque than a control group. The findings, reported in the Journal of Nutritional Biochemistry, suggest that citrulline, a compound found in watermelon, plays a role in cardiovascular health. "We were interested in citrulline because previous studies showed that it may lower blood pressure,"  Shubin Saha, a Purdue Extension vegetable specialist and study co-author, told Medical Xpress. "We didn't see a lowering of blood pressure, but these other changes are promising."

"The researchers fed two groups of mice diets high in saturated fat and cholesterol," MX reports. "Half the mice received water containing 2 percent watermelon juice, while the others received the same amount of water supplemented with a solution that matched the carbohydrate content of the watermelon juice. The mice that consumed watermelon juice gained about 30 percent less weight than the control group and had about 50 percent less LDL cholesterol - the so-called bad cholesterol. The experimental group also had about a 50 percent reduction in plaque in their arteries, as well as elevated levels of citrulline." Sibu Saha, a professor of surgery at UK, explained that the researchers are not sure at what molecular level the citrulline is working, but that is their next step.

Shubin Saha was excited about the dual benefit of the findings. "Twenty percent of each year's watermelon crop is wasted either because the fruit is visibly unappealing to consumers or because some growers find it too expensive to pay for harvesting as prices drop during the height of watermelon season." The wasted melons, he explained, could be put to use extracting these very beneficial compounds.  (Read more)

A study from the University of Kentucky and Purdue University showed that mice fed a diet including watermelon juice had lower weight, cholesterol and arterial plaque than a control group. The findings, reported in the Journal of Nutritional Biochemistry, suggest that citrulline, a compound found in watermelon, plays a role in cardiovascular health. "We were interested in citrulline because previous studies showed that it may lower blood pressure,"  Shubin Saha, a Purdue Extension vegetable specialist and study co-author, told Medical Xpress. "We didn't see a lowering of blood pressure, but these other changes are promising."

"The researchers fed two groups of mice diets high in saturated fat and cholesterol," MX reports. "Half the mice received water containing 2 percent watermelon juice, while the others received the same amount of water supplemented with a solution that matched the carbohydrate content of the watermelon juice. The mice that consumed watermelon juice gained about 30 percent less weight than the control group and had about 50 percent less LDL cholesterol - the so-called bad cholesterol. The experimental group also had about a 50 percent reduction in plaque in their arteries, as well as elevated levels of citrulline." Sibu Saha, a professor of surgery at UK, explained that the researchers are not sure at what molecular level the citrulline is working, but that is their next step.

Shubin Saha was excited about the dual benefit of the findings. "Twenty percent of each year's watermelon crop is wasted either because the fruit is visibly unappealing to consumers or because some growers find it too expensive to pay for harvesting as prices drop during the height of watermelon season." The wasted melons, he explained, could be put to use extracting these very beneficial compounds.  (Read more)

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Pharmacy student takes time to point out the "Top 10 things you didn't know your pharmacist could do for you"

Imagine yourself hip deep in pharmacy school. You are sweating bullets over classes in pharmokinetics, chemotherapy and biostats. What, ho! You see the calendar reads October and you realize it's American Pharmacists Month and you graduate in 2014 from the University of Kentucky's College of Pharmacy and you want people to know you are acquiring mad skills. What to do? Write a primer about how much pharmacists can do for a community. And then put that primer -- via guest column -- in the Kentucky Kernel, the school's (sort-of) daily newspaper, where people who are consumers of good data like this will gobble it and put it to good use. Student Zachary Noel's list of "the top 10 things you didn't know your pharmacist could do for you" is worth repeating because Noel wants to do more than fill prescriptions, he wants to be a trustworthy health-care partner, something a lot of Kentucky communities could use.

Here's Noel's list of what pharmacists can do:
1) Immunize. Kentucky's pharmacists can provide flu shots and vaccinations, even for the human papilloma virus.
2) Economize. Just ask if you find yourself paying too much for your meds, there might be something your pharmacist can do.
3) Educate. Pharmacist are highly educated health-care providers who are often under utilized and more accessible than traditional sources. Don't feel you have to limit those questions to medication questions.
4) Stand guard. Think of pharmacists as a super-filter and your last, best chance to check that a medication is right for you.
5) Counsel. Vitamins, herbals, over-the-counter meds baffling? The evidence-based and experience-tested pharmacist will have some advice.
6) Prescribe. Yes, some pharmacists, writes Noel, "can enter agreements with various providers allowing them to prescribe or alter medication regimens, such as within the Veteran's Affairs hospital system."
7) Practice in interesting places. Like ERs, ORs, with vets.
8) Complete a residency. Pharmacists can opt for more schooling so they can specialize.
9) Medication therapy management. This means that pharmacists can review all your meds for interactions and make recommendations.
10) Compound. This is where they make stuff not already available. Where they create eye drops or topical ointments specifically for your use as directed by your doctor.
(Read more)

Imagine yourself hip deep in pharmacy school. You are sweating bullets over classes in pharmokinetics, chemotherapy and biostats. What, ho! You see the calendar reads October and you realize it's American Pharmacists Month and you graduate in 2014 from the University of Kentucky's College of Pharmacy and you want people to know you are acquiring mad skills. What to do? Write a primer about how much pharmacists can do for a community. And then put that primer -- via guest column -- in the Kentucky Kernel, the school's (sort-of) daily newspaper, where people who are consumers of good data like this will gobble it and put it to good use. Student Zachary Noel's list of "the top 10 things you didn't know your pharmacist could do for you" is worth repeating because Noel wants to do more than fill prescriptions, he wants to be a trustworthy health-care partner, something a lot of Kentucky communities could use.

Here's Noel's list of what pharmacists can do:
1) Immunize. Kentucky's pharmacists can provide flu shots and vaccinations, even for the human papilloma virus.
2) Economize. Just ask if you find yourself paying too much for your meds, there might be something your pharmacist can do.
3) Educate. Pharmacist are highly educated health-care providers who are often under utilized and more accessible than traditional sources. Don't feel you have to limit those questions to medication questions.
4) Stand guard. Think of pharmacists as a super-filter and your last, best chance to check that a medication is right for you.
5) Counsel. Vitamins, herbals, over-the-counter meds baffling? The evidence-based and experience-tested pharmacist will have some advice.
6) Prescribe. Yes, some pharmacists, writes Noel, "can enter agreements with various providers allowing them to prescribe or alter medication regimens, such as within the Veteran's Affairs hospital system."
7) Practice in interesting places. Like ERs, ORs, with vets.
8) Complete a residency. Pharmacists can opt for more schooling so they can specialize.
9) Medication therapy management. This means that pharmacists can review all your meds for interactions and make recommendations.
10) Compound. This is where they make stuff not already available. Where they create eye drops or topical ointments specifically for your use as directed by your doctor.
(Read more)

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Soon-to-be published UK study begins to unravel why prescription pain-killing drug Tramadol is habit-forming

In an attempt to get closer to understanding the plague of prescription pain-killer abuse, a study by a team of University of Kentucky researchers has shed new light on the potential habit-forming properties of the popular pain medication Tramadol. The research was funded by the National Institute on Drug Abuse. The paper is slated to appear in an upcoming edition of the academic journal Psychopharmacology.

"The important thing about this is I think we all assumed that any abuse of Tramadol or any abuse potential Tramadol had was because of the way it activated the opioid receptors in the brain and that may not be the case," said lead study author William W. Stoops of the UK College of Medicine Department of Behavioral Science, the UK Center on Drug and Alcohol Research (CDAR) and the UK College of Arts and Sciences Department of Psychology. "It's pretty well accepted that with opioid drugs like oxycodone, hydromorphone and hydrocodone, when you block the opioid receptors in the brain, folks aren't going to abuse the drug. That is not the case for Tramadol. Opioid receptors are important in Tramadol use and abuse, but they appear to not be the entire story."

Other University of Kentucky researchers involved in the study are Michelle R. Lofwall, Paul A. Nuzzo, Lori B. Craig, Anthony J. Siegel and Sharon L. Walsh.

In an attempt to get closer to understanding the plague of prescription pain-killer abuse, a study by a team of University of Kentucky researchers has shed new light on the potential habit-forming properties of the popular pain medication Tramadol. The research was funded by the National Institute on Drug Abuse. The paper is slated to appear in an upcoming edition of the academic journal Psychopharmacology.

"The important thing about this is I think we all assumed that any abuse of Tramadol or any abuse potential Tramadol had was because of the way it activated the opioid receptors in the brain and that may not be the case," said lead study author William W. Stoops of the UK College of Medicine Department of Behavioral Science, the UK Center on Drug and Alcohol Research (CDAR) and the UK College of Arts and Sciences Department of Psychology. "It's pretty well accepted that with opioid drugs like oxycodone, hydromorphone and hydrocodone, when you block the opioid receptors in the brain, folks aren't going to abuse the drug. That is not the case for Tramadol. Opioid receptors are important in Tramadol use and abuse, but they appear to not be the entire story."

Other University of Kentucky researchers involved in the study are Michelle R. Lofwall, Paul A. Nuzzo, Lori B. Craig, Anthony J. Siegel and Sharon L. Walsh.

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Anthem PPO plan chosen as 'benchmark' for state's Kentucky Health Benefit Exchange

The Kentucky Department of Insurance has recommended that the Anthem Preferred Provider Organization (PPO) plan serve as the “benchmark” plan for the Kentucky Health Benefit Exchange, as well as for plans offered outside the exchange. The statement issued by the department states that "Anthem PPO is the largest small group plan currently offered in Kentucky and includes coverage for all state mandates and the 10 essential health benefits, or categories of care, specified by the federal government under the Patient Protection and Affordable Care Act. The benchmark plan sets the minimum level of benefits offered in the individual and small group markets beginning Jan. 1, 2014."

According to the release, the Anthem PPO plan "is the most cost-effective of the 10 plans reviewed, will not create additional costs for the state and should not increase the price for those who have coverage today. Since the Anthem PPO plan does not offer the minimum requirements for pediatric vision and dental services, Kentucky has recommended that the benefits in the Kentucky Children’s Health Insurance Program (KCHIP) be substituted in the benchmark plan."

Some background, also provided by the Dept. of Insurance: One of the goals of the Affordable Care Act is to ensure that Americans will have access to quality, affordable health insurance. To achieve this goal, the law ensures health plans offered in the individual and small group markets offer a comprehensive package of items and services, known as Essential Health Benefits. The act provides that the EHBs include items and services within at least the following 10 categories: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care. For more on Essential Health Benefits, go here.

The U.S. Department of Health and Human Services will review the Athem recommendation and accept public comments prior to making a final decision on the matter.

The Kentucky Department of Insurance has recommended that the Anthem Preferred Provider Organization (PPO) plan serve as the “benchmark” plan for the Kentucky Health Benefit Exchange, as well as for plans offered outside the exchange. The statement issued by the department states that "Anthem PPO is the largest small group plan currently offered in Kentucky and includes coverage for all state mandates and the 10 essential health benefits, or categories of care, specified by the federal government under the Patient Protection and Affordable Care Act. The benchmark plan sets the minimum level of benefits offered in the individual and small group markets beginning Jan. 1, 2014."

According to the release, the Anthem PPO plan "is the most cost-effective of the 10 plans reviewed, will not create additional costs for the state and should not increase the price for those who have coverage today. Since the Anthem PPO plan does not offer the minimum requirements for pediatric vision and dental services, Kentucky has recommended that the benefits in the Kentucky Children’s Health Insurance Program (KCHIP) be substituted in the benchmark plan."

Some background, also provided by the Dept. of Insurance: One of the goals of the Affordable Care Act is to ensure that Americans will have access to quality, affordable health insurance. To achieve this goal, the law ensures health plans offered in the individual and small group markets offer a comprehensive package of items and services, known as Essential Health Benefits. The act provides that the EHBs include items and services within at least the following 10 categories: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care. For more on Essential Health Benefits, go here.

The U.S. Department of Health and Human Services will review the Athem recommendation and accept public comments prior to making a final decision on the matter.

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