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Under the Medicare Modernization Act of 2003 (Section 231),Congress created a new type of Medicare Advantage coordinated care plan focused on individuals with special needs. "Special needs individuals" (SNP) 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. Final SNP Guidance is in revision. Evaluation of Special Needs Plans Since January of 2007, the Geriatric Measurement Panel (GMAP) of the National Committee for Quality Assurance (NCQA), funded by the Centers for Medicare & Medicaid Services (CMS), has been developing recommendations for evaluating SNPs. In March of 2007, NCQA proposed a potential list of evaluation measures for SNPs which were approved by the GMAP in November 2007. These recommendations included thirteen HEDIS measures, and a set of structure and process measures. On December 12, 2007 NCQA posted structure and process measures and supporting documents for public comment. The public comment period closed on January 18, 2008. SPECIAL NEEDS PLANS STRUCTURE AND PROCESS MEASURES Public comments were considered by the GMAP and used to inform the revisions to the measures. The measures were finalized on March 14, 2008. NCQA and CMS will notify plans and work with them to begin the data collection and submission process. ADDITIONAL SPECIAL NEEDS PLANS RESOURCES Under a contract to CMS, NCQA has been tasked with evaluating the Medicare Advantage Special Needs Plans. The following resources are available, from the link below, on the NCQA web site: Evaluation Approach Memo, SNP HEDIS Reporting FAQs, Public Comments, and a Training Schedule.
Page Last Modified: 09/03/2008 9:54:01 AM
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