The National Voice for Special Needs and Medicare-Medicaid Plans

SNP Alliance Issues

SNP Alliance Priorities

Stabilize SNP legislation
Current SNP legislative provisions contain very little variance from the MA statute for targeting and serving high-risk beneficiaries. The SNP provisions sunset in December of 2008. Refinements are needed for long-term SNP viability. Our strategic priorities are to:

  • Make SNP statutory authority permanent.
  • Make policy enhancements in the areas of financing, performance evaluation, and Medicare-Medicaid integration.
  • Demonstrate added value in care of high-risk beneficiaries.

Advance risk adjustment
SNPs serving a high-risk population cannot be successful over time unless MA payments fully account for the added risk burden of serving high-risk populations. Our strategic priorities are to:

  • Advocate for CMS to assess the CMS-HCC and Rx risk adjusters for frail elders, adults with disabilities and other persons with complex care needs.
  • Advocate for implementation of fair and equitable payment of SNPs in targeting care for high-cost/high-risk beneficiaries.

Advance Medicare/Medicaid integration
The Alliance believes that over the long-term, total quality and cost performance for high-risk groups requires full integration of Medicare and Medicaid. This includes opportunities for all SNPs, including chronic condition and institutional SNPs. Our strategic priorities are to:

  • Provide incentives for States to advance Medicare/Medicaid integration programs.
  • Advance efforts for CMS to establish ongoing structures for monitoring and eliminating inconsistencies in Medicare and Medicaid payment, regulation and oversight and to provide ongoing leadership in Medicare/Medicaid integration. 

Improve performance measurement
SNP are under increased pressure to demonstrate their unique value. To achieve this end, CMS and Congress must establish performance measures and methods that recognize the volatile, complex and ongoing nature of high-risk care. Our strategic priorities are to:

  • Work with CMS, National Quality Forum, and NCQA in establishing new SNP performance measures and methods.
  • Advocate for reporting on complex care management activity including efforts to ensure for safe and effective transitions, care continuity, co-morbidity management, and other efforts of importance in high-cost/high-risk care.