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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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What is the status of SNPs?
The Medicare, Medicaid and SCHIP Extension Act of 2007, signed into law on December 29, 2007, extends the authorization of existing Centers for Medicare & Medicaid Services (CMS)-approved SNPs through December 31, 2009, allowing these existing plans to continue enrollment in the areas the SNP currently serves. The legislation, however, places a freeze on the establishment of new SNPs and the expansion of existing SNPs into new geographic areas.
This year, SNP organizations are seeking legislation that would extend the program's authorization at least until 2012 and to remove the moratorium. This proposal, as well as significant reforms to SNPs, are under active consideration by Congress, and may be included in this year's Medicare package. These reforms could include additional SNP-specific quality measures, stronger coordination between Medicare and Medicaid for dually eligible beneficiaries, and additional consumer protection and accountability measures. The Medicare Payment Advisory Commission (MedPAC) has expressed some concerns related to the rapid growth of SNPs since their inception, and made similar recommendations in December 2007.
SNP oversight has also been addressed by the National Committee on Quality Assurance (NCQA) through the release of specific quality measures focused on SNPs in March 2008. NCQA is a private, not-for-profit organization that is dedicated to driving improvement and improving health care quality. CMS has contracted with NCQA to evaluate Medicare SNPs. The evaluation includes the collection of SNP specific HEDIS measures as well as structure and process measures. By June 2008, SNPs will be required to report on 13 HEDIS measures specific to SNPs that were issued by NCQA in March 2008. The measures can be found on NCQA's website. NCQA is conducting web-based training sessions focused on processes for submitting data through NCQA's data collection tools and the requirements for SNP evaluation.
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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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