Time to Reauthorize Special Needs Plans

Special Needs Plans (SNPs) are a special type of health plan for America’s most vulnerable and complex seniors that are set to expire at the end of 2013. Over 500 SNPs serve more than 1.5 million Medicare beneficiaries across the United States. Done well, the SNP significantly improves outcomes and brings down costs thanks to personal care planning, care-transition assistance, disease management, and medication therapy management.  Not all SNPs are good at what they’re designed to accomplish, but there are many providing patient-centered, coordinated care to vulnerable populations showing signs of success — the program should be allowed to continue.

There are three types of SNPs since their launch in 2006: Institutional SNPs serve individuals who reside in institutional settings or are eligible for skilled nursing. Chronic SNPs serve individuals living with multiple chronic conditions, such as diabetes, congestive heart failure, and end-stage renal disease. Dual-eligible SNPs serve those eligible for both Medicare and Medicaid (MediCal in California).

An April 2012 study found that SCAN Health Plan’s dual-eligible members had a hospital readmission rate that was 25%lower than dual eligibles with identical risk profiles in Medicare fee-for-service. The study also found that SCAN performed 14% better than fee-for-service on keeping people out of the hospital for preventable conditions and episodes of care.

A five-year extension for SNPs would stabilize specialty care for the 1.5 million beneficiaries in SNPs while continuing the progress they are making in reducing emergency department visits, hospitalizations, re-hospitalizations and nursing home stays. An extension would also allow states, if they choose, to construct their duals and long-term care demonstrations on a SNP framework, and allow time to evaluate findings from SNPs so that CMS can work with Congress to enact a permanent program going forward.