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MedPAC to Congress: Renew Medicare’s special needs plans for long-term care

January 14, 2013
by Pamela Tabar, Associate Editor
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The Medicare Payment Advisory Commission (MedPAC) has urged Congress to permanently renew the Medicare Advantage special needs plans (SNPs), which cover thousands of long-term care residents who have special care needs. Without congressional action, the enrollment authority for SNPs will expire at the end of 2014.

In a presentation January 10, the commission delivered a unanimous recommendation to retain three Medicare Advantage plans that cover beneficiaries with specific medical situations: D-SNPs (for dual-eligibles), I-SNPs (for institutionalized beneficiaries) and C-SNPs (for those with chronic diseases). Duals-SNPs “that do not assume clinical and financial responsibility for Medicare and Medicaid benefits” have been called into question as recently as November, notes InsideHealthPolicy.

Unlike traditional Medicare plans, SNPs have very specific enrollment rules and can tailor their coverage structures to specific populations, such as those with chronic conditions or institutional needs.

  • D-SNPs: (1.3 million enrollees, 2012) These plans have high star ratings but not always the best performance. This model also still encounters problems interacting with Medicaid, medPAC’s presentation noted.
  • C-SNPs: (233,000 emrollees, 2012) These plans have not fared as well as other Medicare Advantage models, often having disappointing ratings and high readmisison rates, according to MedPAC’s presentation.
  • I-SNPs: (50,000 enrollees, 2012) Although I-SNPs generally cost a bit more than fee-for-service plans, they tend to do a better job of reducing readmissions and delivering coordinated care than other Medicare plans, noted the presentation.

View MedPAC’s powerpoint presentation to Congress.

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