Medicare SNP Reauthorization
Congress Should Reauthorize Medicare Advantage Special Needs Plans and Ensure Plans Have the Capabilities to Care for Special Needs Individuals
Request
The Association for Community Affiliated Plans (ACAP) supports the reauthorization of the Medicare Advantage Special Needs Plans (SNP) program in conjunction with the establishment of standards for SNPs to ensure they have the focus, experience and capabilities to care for vulnerable, chronically-ill beneficiaries. ACAP believes that Section 431 of the House SCHIP reauthorization package (H.R.3162) makes great progress in achieving these goals and encourages the inclusion of section 431 in the conference version of the legislation.
Background
Section 231 of the Medicare Modernization Act of 2003 created a new type of Medicare Advantage coordinated care plan focused on individuals with special needs. "Special needs individuals" were identified by Congress as: 1) institutionalized; 2) dually eligible; and/or 3) individuals with severe or disabling chronic conditions. Congressional SNP authority expires in December 2008.
ACAP and our member plans strongly believe that the SNP program serves an important and vital role in meeting the needs of low-income, chronically ill, and institutionalized Medicare beneficiaries. Many of these beneficiaries have complex, co-morbid medical conditions that may include serious behavioral health conditions. In addition to their health conditions, low-income beneficiaries (many of which are dually eligible for both Medicare and Medicaid) experience many non-medical obstacles, including, but not limited to, hunger, homelessness, lack of transportation, and limited English proficiency. Given these medical and non-medical challenges faced by many dual eligible beneficiaries, it is critical that the SNPs serving dual eligible beneficiaries have:
- Linguistically and culturally appropriate communications, both written and telephonic;
- Capabilities to assist beneficiaries with Medicaid and Medicare eligibility;
- Ability to link beneficiaries with community based social services;
- Ability to assist beneficiaries in coordinating Medicare, Medicaid and social service through the plan; and
- Complex care management capabilities to meet the health needs of dual eligible beneficiaries.
Support for Section 431 of H.R. 3162
ACAP supports the adoption of standards for MA Special Needs Plans that ensure plans have the focus, capabilities and experience to serve special needs individuals. Section 431 of H.R. 3162 advances these goals through a number of provisions, including the requirement that at least 90 percent of a plan’s enrollment be comprised of special needs individuals the plan is designed to support. In addition, the legislation requires plans serving dual eligible beneficiaries to have an agreement with the State Medicaid Agency that ensures coordination on the financing of care for dual eligible beneficiaries. Additional provisions further ensure integration of Medicare and Medicaid and take important steps to allow the Secretary to measure and monitor plans’ quality of care. ACAP supports this legislation and encourages its inclusion in the conference version of H.R. 3162.
Medicare SNP Reauthorization
Congress Should Reauthorize Medicare Advantage Special Needs Plans and Ensure Plans Have the Capabilities to Care for Special Needs Individuals
Request
The Association for Community Affiliated Plans (ACAP) supports the reauthorization of the Medicare Advantage Special Needs Plans (SNP) program in conjunction with the establishment of standards for SNPs to ensure they have the focus, experience and capabilities to care for vulnerable, chronically-ill beneficiaries. ACAP believes that Section 431 of the House SCHIP reauthorization package (H.R.3162) makes great progress in achieving these goals and encourages the inclusion of section 431 in the conference version of the legislation.
Background
Section 231 of the Medicare Modernization Act of 2003 created a new type of Medicare Advantage coordinated care plan focused on individuals with special needs. "Special needs individuals" were identified by Congress as: 1) institutionalized; 2) dually eligible; and/or 3) individuals with severe or disabling chronic conditions. Congressional SNP authority expires in December 2008.
ACAP and our member plans strongly believe that the SNP program serves an important and vital role in meeting the needs of low-income, chronically ill, and institutionalized Medicare beneficiaries. Many of these beneficiaries have complex, co-morbid medical conditions that may include serious behavioral health conditions. In addition to their health conditions, low-income beneficiaries (many of which are dually eligible for both Medicare and Medicaid) experience many non-medical obstacles, including, but not limited to, hunger, homelessness, lack of transportation, and limited English proficiency. Given these medical and non-medical challenges faced by many dual eligible beneficiaries, it is critical that the SNPs serving dual eligible beneficiaries have:
- Linguistically and culturally appropriate communications, both written and telephonic;
- Capabilities to assist beneficiaries with Medicaid and Medicare eligibility;
- Ability to link beneficiaries with community based social services;
- Ability to assist beneficiaries in coordinating Medicare, Medicaid and social service through the plan; and
- Complex care management capabilities to meet the health needs of dual eligible beneficiaries.
Support for Section 431 of H.R. 3162
ACAP supports the adoption of standards for MA Special Needs Plans that ensure plans have the focus, capabilities and experience to serve special needs individuals. Section 431 of H.R. 3162 advances these goals through a number of provisions, including the requirement that at least 90 percent of a plan’s enrollment be comprised of special needs individuals the plan is designed to support. In addition, the legislation requires plans serving dual eligible beneficiaries to have an agreement with the State Medicaid Agency that ensures coordination on the financing of care for dual eligible beneficiaries. Additional provisions further ensure integration of Medicare and Medicaid and take important steps to allow the Secretary to measure and monitor plans’ quality of care. ACAP supports this legislation and encourages its inclusion in the conference version of H.R. 3162.
ACAP Submits Testimony to House E&C - Health Subcommittee on the Value of SNPs - Wednesday, March 12, 2008
ACAP submitted testimony about the value of Special Needs Plans to the House Energy and Commerce - Health Subcommittee in response to a hearing held February 28, 2008 on the cost, benefits and marketing practices within the Medicare Advantage program. Our written statement highlighted the value of SNPs from the paper,” Medicare Advantage Special Needs Plans/Six Plans’ Experience with Targeted Care Models to Improve Dual Eligible Beneficiaries’ Health and Outcomes commissioned by Association for Community Affiliated Plans and prepared by Avalere Health.
ACAP Record of Submission for Hearing
ACAP Submits Testimony to House E&C - Health Subcommittee on the Value of SNPs - Wednesday, March 12, 2008
ACAP submitted testimony about the value of Special Needs Plans to the House Energy and Commerce - Health Subcommittee in response to a hearing held February 28, 2008 on the cost, benefits and marketing practices within the Medicare Advantage program. Our written statement highlighted the value of SNPs from the paper,” Medicare Advantage Special Needs Plans/Six Plans’ Experience with Targeted Care Models to Improve Dual Eligible Beneficiaries’ Health and Outcomes commissioned by Association for Community Affiliated Plans and prepared by Avalere Health.
ACAP Record of Submission for Hearing
ACAP with Avalere Release Report on SNPs
The report looks at 6 ACAP SNP plans and how ACAP SNP plans are designed to lower costs and increase quality through:
- Tailored care management
- Low income social support services
- Coordination of Medicaid and Medicare benefit
ACAP/AVALERE SNP Report
ACAP with Avalere Release Report on SNPs
The report looks at 6 ACAP SNP plans and how ACAP SNP plans are designed to lower costs and increase quality through:
- Tailored care management
- Low income social support services
- Coordination of Medicaid and Medicare benefit
ACAP/AVALERE SNP Report
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