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What are Medicare Advantage Special Needs Plans?
Chronic illnesses are the leading cause of death in the U.S. A 2004 study found that people with five or more chronic conditions comprised more than 20 percent of Medicare beneficiaries, but accounted for two-thirds of the program's costs. To help address this, Congress established Medicare Advantage Special Needs Plans (SNPs) under the Medicare Modernization Act of 2003 to ensure that Medicare beneficiaries with complex health needs and chronic conditions receive coordinated health coverage tailored to their needs. The number of authorized SNPs has grown from 11 plans in 2004 to 775 plans in 2008 with more than one million Medicare beneficiaries enrolled in SNPs nationwide.
SNPs are similar to regular Medicare Advantage plans but have limited enrollment to provide specialized care exclusively for special needs populations such as the elderly and chronically ill.
Public Law, PL 108-173, 117 Stat. 2066 authorizes three types of SNPs in order to serve:
- dual-eligible beneficiaries
- institutionalized beneficiaries
- patients with severe chronic diseases or conditions
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Why are SNPs important?
AGS believes that SNPs provide an opportunity to focus benefits, formularies, provider networks, etc., on managing the needs of the highest risk beneficiaries, as well as an opportunity to focus on specific diseases such as Alzheimer's and other chronic illnesses.
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What is AGS' position on SNPs?
The American Geriatrics Society is in favor of the legislation that would extend the SNPs authorization until 2012 and remove the moratorium. We also support the final structure and process measures for the SNP population as determined by CMS/NCQA and GMAP.
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