|
Under the Medicare Modernization Act of 2003 (MMA), Congress created a new type of Medicare Advantage coordinated care plan focused on individuals with special needs. Special needs plans (SNPs) were allowed to target enrollment to one or more types of special needs individuals identified by Congress as: 1) institutionalized; 2) dually eligible; and/or 3) individuals with severe or disabling chronic conditions. Congress has since passed additional legislation affecting SNPs. For example, MMA Congressional SNP authority was first set to expire in December 2008. The "Medicare, Medicaid, and SCHIP extension Act of 2007" extended the SNP program from December 31, 2008 to December 31, 2009, but put in place a moratorium on the designation of new SNPs after January 1, 2008. Most recently, the "Medicare Improvements for Patients and Providers Act of 2008" (MIPPA), lifted the moratorium and extended the SNP program through December 31, 2010. The MIPPA extension, however, placed several new requirements on SNPs which are further explained in guidance on this web-page. Final SNP Guidance is in revision. The MIPPA statute required CMS to convene a panel of clinical advisers to identify the chronic conditions that met the MIPPA-clarified definition of "severe or disabling." CMS solicited public comments on the identification of SNP-specific chronic conditions through an Open Door Forum on September 10, 2008, and received 87 written comments through an electronic mailbox maintained from September 10 through October 1, 2008. The six Panelists included five physicians and a clinical pharmacist from three Federal agencies: the Agency for Healthcare Research and Quality, the Center for Disease Control and Prevention, and CMS. During their deliberations, the Panelists reviewed public comments, considered chronic conditions currently targeted by existing chronic condition SNPs, and applied their considerable experience in chronic disease management to derive recommendations for the Secretary. The Panel concluded its mission on October 16, 2008, and submitted fifteen (15) SNP-specific chronic conditions that met the MIPPA definition of severe or disabling to the Secretary. The fifteen SNP-specific chronic conditions approved for 2010 are: 1) Chronic alcohol and other drug dependence; 2) certain auto-immune disorders; 3) cancer (excluding pre-cancer conditions; 4) certain cardiovascular disorders; 5) chronic heart failure; 6) dementia; 7) diabetes mellitus; 8) end-stage liver disease; 9) end-stage renal disease requiring dialysis; 10) certain hematologic disorders; 11) HIV/AIDS; 12) certain chronic lung disorders; 13) certain mental health disorders; 14) certain neurologic disorders; and 15) stroke. All readers are cautioned that the fifteen SNP-specific chronic conditions have limited utility as a Medicare Advantage health plan product, and should not be generalized for any other purpose. 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. Under a contract to CMS, NCQA has been tasked with evaluating the Medicare Advantage Special Needs Plans. Work continues with respect to refining and improving SNP evaluation, including the development of SNP-specific measures. 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: 12/10/2008 10:08:00 AM
Help with File Formats and Plug-Ins
Submit Feedback
|
Email
Print