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. CMS Requirements for SNPs
As of October 2018, CMS had approved 297 MA contracts offering 641 Special Needs Plans (SNPs) with a total enrollment of 2,805,749 beneficiaries. Of these 641 Special Needs Plans, 132 are Chronic or Disabling Condition SNPs serving 366,981; 412 are Dual-Eligible SNPs serving 2,359,263 beneficiaries; and 97 Institutional SNPs are serving 79,505 beneficiaries. (View full report here.)
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 models to better integrate primary, acute, behavioral health, and long-term services and supports, providing participating states to share in savings. Fifteen states were initially 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 July 2018, 9 states are participating in the capitated model (CA, IL, MA, MI, NY (two demonstrations), OH, RI, SC, TX) with total enrollment of 379,047 (July 2018). One state is in the managed fee-for-service model (WA) with enrollment of about 33,000 (September 2017.) One additional state (MN) has an agreement with CMS for an alternative FIDE-SNP demonstration focused on administrative alignments with enrollment of about 38,570 (September 2017). Two demonstrations have ended (VA and CO) though additional care coordination was continued. Three of the demonstrations (MN, MA and WA) are in process of being extended through December 2020.
For more information about MMPs, D-SNPs and Medicare-Medicaid Integration click on the links below: