The Medicare Modernization Act of 2003 established a new type of Medicare Advantage coordinated care plans called special needs plans (SNPs) to focus on individuals with special needs.
Special needs individuals are defined as individuals who are:
Congress intended for SNPs to exclusively or disproportionately enroll persons with serious chronic conditions to more effectively serve high-risk populations through specialization. SNPs must offer Medicare Parts A, B, and D benefits. SNPs function under most of the same Medicare Advantage regulations, with some exceptions, and use the same payment methodology as other MA plans. The most significant exception relates to enrollment. Dual and institutional beneficiaries can enroll in and disenroll from a SNP anytime throughout the year. Chronic Condition beneficiaries have a one-time special election period, based on their being diagnosed with a condition that qualifies them for SNP enrollment.
As of April 2018, CMS had approved 297 MA contracts offering 641 Special Needs Plans (SNPs) with a total enrollment of 2,633,378 beneficiaries. Of these 641 Special Needs Plans, 132 are Chronic or Disabling Condition SNPs serving 349,235; 412 are Dual-Eligible SNPs serving 2,209,691 beneficiaries; and 97 Institutional SNPs are serving 74,452 beneficiaries. (Click to view the most recent monthly CMS' Comprehensive Report.)
This site contains access to application material, identifies approved SNPs, and includes government-sponsored SNP reports and other information about SNP development and implementation.
The Centers for Medicare & Medicaid Services (CMS) Financial Alignment Initiative is testing two models to better integrate primary, acute, behavioral health, and long-term services and supports, providing participating states to share in savings. Fifteen states were awarded demonstration contracts, and implementation began in 2013. The two models include (1) a prospective blended rate model for select health plans to provide both Medicare and Medicaid benefits to duals called the "capitated model", and (2) a model that allows the state to take responsibility for coordinating the beneficiary's care, called a "managed fee-for-service model (MFFS)".
As of February 2017, ten states are participating in the capitated model (CA, IL, MA, MI, NY, OH, RI, SC, TX, VA) and two in the managed fee-for-service model (CO, WA). Total enrollment in the capitated and MFFS model demonstrations was nearly 450,000 in February 2017. One additional state (MN) signed an agreement with CMS for an alternative FIDE-SNP demonstration focused on administrative alignments.
For more information about MMPs, D-SNPs and Medicare-Medicaid Integration click on the links below: