The National Voice for Special Needs and Medicare-Medicaid Plans

CMS-SNP Guidance

CMS-SNP Guidance

Special Needs Plans must comply with all Medicare Advantage rules except where the law provides for variance or CMS has the authority to modify rules. Key differences between SNPs and standard MA plans include the following:

  • SNPs can limit enrollment to targeted special needs individuals.
  • Dually eligible and institutionalized beneficiaries may enroll and disenroll throughout the year.
  • Beneficiaries who qualify for a chronic condition SNP have a one-time enrollment option outside of standard enrollment periods.
  • SNPs integrating Medicare and Medicaid benefits may target enrollment to certain subsets of dual beneficiaries.
  • All SNPs must offer Part D coverage.

Medicare Advantage applications, including SNP applications, and Part D applications typically are due in February of the year preceding the contract year. Application guidance for both Part C Medicare Advantage and Medicare Prescription Drug Plans is available on the CMS website.

CMS includes a timeline outlining submission dates for various components of the application and SNP approval process such as drug formularies and bids in the annual Call Letter.  The 2019 Call Letter is available on CMS’ website.